Blue Care® Elect Saver Benefits at a Glance
Plan Specifics You Pay (In-Network)
Plan-year deductible $1,500 (individual), $3,000 (family)
Plan-year out-of-pocket maximum for in-network and out-of-network services combined $3,000 (individual), $6,000 (family)
Benefit You Pay (In-Network)
Preventive care, routine physicals, GYN, well child, routine hearing and vision exams, family planning Nothing, no deductible
Office visits (sick care and non-preventive) Nothing after deductible
Office visits (specialists) Nothing after deductible
Urgent care Nothing after deductible
Emergency room Nothing after deductible
Inpatient hospital care Nothing after deductible

 

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Dependent Benefits

This plan covers dependents to the end of the month in which the dependent turns 26, even if they aren't considered dependents on a tax return and 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. The plan-year out-of-pocket maximum for prescription drug coverage is $1,000 per member or $2,000 per family.

Prescription Drug Benefits You Pay
Retail pharmacies (up to a 30-day supply) $10 for Tier 11
$30 for Tier 2
$65 for Tier 3
Mail service pharmacy (up to a 90-day supply) $25 for Tier 11
$75 for Tier 2
$165 for Tier 3

1. Cost share waived for Tier 1 birth control

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