Medical insurance for individuals and families

To stay healthy, you want to make sure you have access to the best health care possible. OneBlue offers a wide range of quality benefits to provide the protection you and your family need, when you need it.

OneBlue Benefits-at-a-Glance

Download OneBlue Benefits (112K PDF)

Benefit highlights

    Annual deductible
    $500 per individual contract per calendar year.

$1,000 per family contract (two or more members) per calendar year.
  

    Copays
    
            	Fixed dollar copay:
                $5 for allergy injections, $30 office visits, $35 for urgent care visits, $100 for emergency room visits.
            
            	Percent copay:
                20%, 25% or 50% for specific services defined below

    Annual maximums
    
            	Fixed dollar copay
                None
            
            	Percent dollar copay for medical services; excludes services with a 50% copay
                $5,000 per individual contract per calendar year.
$10,000 per family contract (two or more members) per calendar year.
            
            	Percent dollar copay – inpatient mental health care
                $1,000 per individual contract.
$2,000 per family contract (two or more members).

    Lifetime maximum
    None
  

Preventive services

    Pre-existing conditions clause
    All benefits are subject to a 180-day waiting period for pre-existing conditions.
  

    Health maintenance exam
    Covered – $30 copay
  

    Annual gynecological exam
    Covered – $30 copay
  

    Pap smear screening (laboratory services only)
    Covered – Office visit copay may apply per member, per visit
  

    Well-baby and child care
    Covered – $30 copay
  

    Pediatric and adult immunizations
    Covered – Office visit copay may apply per member, per visit
  

    Prostate specific antigen screening
(laboratory services only)
    Covered – Office visit copay may apply per member, per visit
  

    Mammography screening
    Covered – 100%
  

Physician office services

    Office visits
    Covered – $30 copay; deductible applies for specialty care
  

    Consulting specialist care
    Covered (if referred) – $30 copay after deductible
  

Emergency medical care

    Hospital emergency room
    Covered – $100 copay after deductible; copay waived if admitted; inpatient copay will apply
  

    Urgent care
    Covered – $35 copay
  

    Ambulance service: medically necessary, emergency ground transport and air ambulance
    Covered – 80% after deductible
  

Diagnostic services

    Laboratory tests and pathology
    Covered – Office visit copay may apply per member, per visit
  

    Diagnostic tests and X-rays
    Covered – 80% after deductible
  

    Radiation therapy
    Covered – 80% after deductible
  

Maternity services provided by a physician

    Pre and postnatal care
    Covered – $30 copay
  

    Delivery and nursery care
    Covered – 100% after deductible
  

Inpatient hospital care

    Semi-private room, general nursing care, hospital services and supplies
    Covered – 80% after deductible; unlimited days
  

Surgical services

    Surgery includes all related surgical services and anesthesia. See member certificate for specific surgical copays.
    Covered – 80% after deductible
  

    Voluntary sterilization
    Covered – 50% after deductible
  

    Human organ transplants
    Covered – 80% after deductible; subject to medical criteria
  

Alternatives to hospital care

    Skilled nursing care
    Covered – 80% after deductible; 45 days per calendar year
  

    Hospice care
    Covered – 100% after deductible
  

    Home health care
    Covered – $30 copay after deductible
  

Other medical benefits

    Allergy testing and therapy
    Covered – 50% after deductible, $5 copay for allergy injections
  

    Chiropractic spinal manipulation
    Covered (if referred) – $30 copay after deductible
  

    Outpatient physical, speech and occupational therapy
    Covered – $30 copay after deductible, limited to 60 consecutive days per episode for a combination of therapies
  

    Infertility counseling and treatment
(excludes in-vitro fertilization)
    Covered – 50% after deductible
  

    Durable medical equipment
    Covered – 50%
  

    Temporomandibular Joint Syndrome Treatment
    Covered – 50% after deductible
  

    Prosthetic and orthotic appliances
    Covered – 50%
  

Mental health care and substance abuse treatment

    Inpatient mental health care and substance abuse care
    Mental health care:
Covered – 75% with a 25% copay up to $1,000 per member, $2,000 per family; 30 days per calendar year


    Substance abuse care:
Covered – 50%, one program of treatment per year, up to state mandated dollar limitation, which is adjusted annually by the state.
  

    Outpatient mental health care
    Covered – 50%, 20 visits per calendar year
  

    Outpatient substance abuse care
    Covered – 50%, one program of treatment per year, up to state mandated dollar limitation, which is adjusted annually by the state.

NOTE: A program of treatment may include outpatient or immediate services or both.
  

Prescription drugs

    Includes mail-order prescription drugs
    $5 generic and $50 brand retail copay with contraceptives and mail order

$10 generic and $100 brand copay up to 90-day supply; $2,500 benefit maximum
  

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Medical insurance for individuals and families

OneBlue Benefits-at-a-Glance

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