Medical Plans
We always want to provide you with best plans at the best possible price. There will be a 6.1% cost increase this year for both PPO and HMO plans.
Deductible amounts in the PPO plan are increasing from $1,500 to $1,600 for individual coverage and $3,000 to $3,200 for individual +1 or family coverage.
Explore your plan options:
Payment Details
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Annual Deductible | Individual: $1,600 Individual +1: $3,200 Family: $3,200 |
Individual: $1,250 Individual +1: $2,500 Family: $2,500 |
| Paycheck Contributions (Annualized base salary <$80K) |
Individual: $31.03 Individual +1: $61.67 Family: $89.71 |
Individual: $50.49 Individual +1: $100.49 Family: $146.60 |
| Paycheck Contributions (Annualized base salary ≥$80K) |
Individual: $47.86 Individual +1: $95.27 Family: $139.70 |
Individual: $71.24 Individual +1: $141.93 Family: $208.12 |
| Contributions from Blue Cross (Annualized base salary <$80K) |
Individual: $1,225 Individual +1: $2,450 Family: $2,450 |
Individual: $400 Individual +1: $800 Family: $1,000 |
| Contributions from Blue Cross (Annualized base salary ≥$80K) |
Individual: $850 Individual +1: $1,700 Family: $1,700 |
Individual: $400 Individual +1: $800 Family: $1,000 |
| Net Deductible: the remaining balance of your deductible after using Blue Cross contributions (Annualized base salary <$80K) |
Individual: $375 Individual +1: $750 Family: $750 |
Individual: $850 Individual +1: $1,700 Family: $1,500 |
| Net Deductible: the remaining balance of your deductible after using Blue Cross contributions (Annualized base salary ≥$80K) |
Individual: $750 Individual +1: $1,500 Family: $1,500 |
Individual: $850 Individual +1: $1,700 Family: $1,500 |
| Out-of-Pocket Maximum | Individual: $5,000 Individual +1: $10,000 Family: $10,000 |
Individual: $3,000 Individual +1: $6,000 Family: $6,000 |
How to Determine Your Net Deductible
The net deductible is the remaining balance of your deductible after using Blue Cross contributions. To calculate the net deductible, take the annual deductible amount less contributions from Blue Cross (HSA or HRA). Refer to the amounts in the chart above to calculate your own net deductible.
Example:
Pat needs family coverage and has an annualized base salary of less than $80,000.
Based on the rates in the chart above, see how Pat would find the Net Deductible for each plan.
| PPO Plan | HMO Plan | |
|---|---|---|
| Annual Deductible | $3,200 | $2,500 |
| Subtract Contributions by Blue Cross | $2,450 | $1,000 |
| Net Deductible | $750 | $1,500 |
Medical Services Costs
Co-insurance/Copayments
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Your Cost | You must meet the deductible amount first, then you’ll pay 10% co-insurance (when required) | $25-$150 copayments (specific services subject to deductible) |
Medical
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Preventive Care | $0, no deductible | $0, no deductible |
| Emergency Room (ER) | Deductible, then $150 copay1 | $150 copay, no deductible1 |
| Urgent Care | Deductible, then co-insurance | $35 copay, no deductible |
| PCP Visit | Deductible, then co-insurance | $25 copay, no deductible |
| Specialist Visit | Deductible, then co-insurance | $35 copay, no deductible3 |
Hospital Care
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Inpatient/Outpatient | Deductible, then co-insurance1, 2 | Deductible, then $01 |
Tests
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Diagnostics (X-rays, lab tests) | Deductible, then co-insurance | Deductible, then $0 |
| Imaging (CT/PET Scans, MRIs) | Deductible, then co-insurance2, 4 | Deductible, then $75 copay2, 4 |
Mental Health or Substance Use Disorder
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Inpatient | Deductible, then co-insurance2 | Deductible, then $02 |
| Outpatient | Deductible, then co-insurance | $25 copay, no deductible |
Pregnancy Care
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Prenatal | $0, no deductible | $0, no deductible |
| Postnatal | Deductible, then co-insurance | $0, no deductible |
| Inpatient (including delivery) | Deductible, then co-insurance | Deductible, then $0 |
Telehealth
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Minor medical care | Deductible, then co-insurance for medical care | $25 copay for medical care, no deductible |
| Therapy | Deductible, then co-insurance for therapy | $25 copay for therapy, no deductible |
| Psychiatry | Deductible, then co-insurance for psychiatry | $25 copay for psychiatry, no deductible |
1. Copay waived if admitted or for observation stay.
2. Prior authorization required.
3. Under this plan, you're required to select a PCP and will need a referral from your PCP to see a specialist.
4. Coverage and cost-sharing limitations and/or exceptions may apply. Visit bluecrossma.org/associate to see the Summary of Benefits and Coverage for more information.