Blue Care Elect Preferred Benefits at a Glance
Plan Specifics You Pay (In-Network)
Calendar-year deductible Nothing
Calendar-year out-of-pocket max $4,500 per member or $9,000 per family

Benefit You Pay (In-Network)
Preventive care, routine physicals, GYN, well child, routine hearing and vision exams, family planning Nothing
Office visits (sick care/non-preventive) $20
Office visits (specialists) $30
Emergency room $100
Inpatient hospital care $50*
Outpatient surgery $50*
CT scan, MRI, and other imaging tests $50*

*Copayment limited to $50 per member per plan year.

Download Summary of Benefits + Coverage Download Summary of Benefits + Coverage
Download Summary of Benefits + Coverage Download Summary of Benefits
Dependent Benefits

This plan covers dependents to the end of the month in which the dependents turn 26, even if they aren't considered dependents on a tax return, don't attend school, and regardless of whether or not they have a job.

Prescription Drug Coverage

Your plan includes prescription drug coverage. Covered medications are separated into three tiers, and the amount you pay depends on the medication's tier.

Prescription Drug Benefits You Pay
Retail pharmacies (up to a 30-day supply) $10 for Tier 11
$30 for Tier 2
$55 for Tier 3
Mail service pharmacy (up to a 90-day supply) $20 for Tier 11
$60 for Tier 2
$135 for Tier 3

1. Cost share waived for birth control.

Medication Look Up Medication Look Up
Express Scripts Mobile App Express Scripts Mobile App
Find a Pharmacy Find a Pharmacy