Our Medical Plans
The best insurance is the kind you understand. Learn more about the payment details and costs for both plans.
Payment Details
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Annual Deductible | Individual: $1,500 Individual +1: $3,000 Family: $3,000 |
Individual: $1,250 Individual +1: $2,500 Family: $2,500 |
| Paycheck Contributions (Annual salary <$70K) |
Individual: $29.25 Individual +1: $58.12 Family: $84.55 |
Individual: $45.67 Individual +1: $90.90 Family: $132.60 |
| Paycheck Contributions (Annual salary ≥$70K) |
Individual: $43.29 Individual +1: $86.17 Family: $126.36 |
Individual: $64.44 Individual +1: $128.38 Family: $188.25 |
| Contributions from Blue Cross (Annual salary <$70K) |
Individual: $1,125 Individual +1: $2,250 Family: $2,250 |
Individual: $400 Individual +1: $800 Family: $1,000 |
| Contributions from Blue Cross (Annual salary ≥$70K) |
Individual: $750 Individual +1: $1,500 Family: $1,500 |
Individual: $400 Individual +1: $800 Family: $1,000 |
| Net Deductible: the remaining balance of your deductible after using Blue Cross contributions (Annual salary <$70K) |
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 (Annual salary ≥$70K) |
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
A Blue Cross-funded account is automatically paired with each medical plan to help offset a portion of your annual deductible.
Example:
Pat needs family coverage and has an annual salary of less than $70,000.
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 | $3,000 | $2,500 |
| Subtract Contributions by Blue Cross | $2,250 | $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 only 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-insurance2 | Deductible, then $01 |
Mental/Behavioral Health or Substance Use Disorder
| Blue Care Elect Saver—Choice (PPO) | Network Blue New England Deductible (HMO) | |
|---|---|---|
| Inpatient | Deductible, then co-insurance2 | Deductible, then $0 |
| 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 |
| Therapy | Deductible, then co-insurance for therapy | $25 copay for therapy |
| Psychiatry | Deductible, then co-insurance for psychiatry | $25 copay for psychiatry |
1. Copay waived if admitted or for observation stay.
2. Prior authorization required.
3. Under this plan, you are required to select a PCP and will need a referral from your PCP to see a specialist.
4. Changes and cost-sharing limitations and/or exceptions may apply. For more information, review the overview of benefits and coverage under each medical plan option.