Update

Blue Care Network HMO Fixed CostSM

This 2021 plan offers simplicity for both you and your employees. It's a copay-only plan so there's no cost uncertainty for your employees.

Plan highlights
  • Simple copay-only structure makes this plan easy to understand.
  • Prescription drug coverage is included.
  • Preventive care is 100% covered.

NETWORK SIZE

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PREMIUM COST

$$$

LEVEL OF CONSUMER ENGAGEMENT

Low

INDIVIDUAL DEDUCTIBLE

$0

HOW A COPAY-ONLY PLAN WORKS

A copay-only plan means your employees will only have to worry about just that — paying copays. They'll know what they need to pay before they go. No more figuring out percentages or deductibles.

This plan also includes these features:

  • Certain services will apply a flat dollar copay or are otherwise covered in full
  • No deductible or coinsurance for medical and pharmacy services
  • Employees pay a copay for certain services instead of a deductible or coinsurance
  • Copay amounts are set based on the type of service and place of service
Want more details about BCN Fixed Cost?

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Plan options for 2021

Platinum

This is a top-level plan with a $0 deductible. The copays listed are not a complete list of services that require a copay.

Monthly premium

High

Deductible

$0

Out-of-pocket maximum

$4,000

PCP office visit copay

$15

Individual annual deductible

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

In network

$0

Out of network

Not covered

Family annual deductible

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

In network

$0

Out of network

Not covered

Coinsurance percentage

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

In network

0%

Out of network

Not covered

Embedded coinsurance maximum

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network

Not covered

Out of network

Not covered

Individual out-of-pocket maximum

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network

$4,000

Out of network

Not covered

Family out-of-pocket maximum

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network

$8,000

Out of network

Not covered

PCP office visit copay

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

In network

$15

Out of network

Not covered

Specialist care copay (when referred)

In network

$40

Out of network

Not covered

Retail health clinic copay

In network

$40

Out of network

Not covered

Urgent care copay

In network

$40

Out of network

Not covered

Emergency room copay

In network

$250

Out of network

Not covered

Ambulance copay (when medically necessary)

In network

$100

Out of network

Not covered

Preferred generic pharmacy copay

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

In network

$4

Out of network

Not covered

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

 $0 Not covered

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

 $0 Not covered

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

 0% Not covered

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

 Not covered Not covered

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

 $4,000 Not covered

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

 $8,000 Not covered

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

 $15 Not covered

$40 Not covered

$40 Not covered

$40 Not covered

$250 Not covered

$100 Not covered

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

 $4 Not covered

Gold

This is a mid-level plan with a $0 deductible. The copays listed are not a complete list of services that require a copay.

Monthly premium

Medium

Deductible

$0

Out-of-pocket maximum

$6,500

PCP office visit copay

$20

Individual annual deductible

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

In network

$0

Out of network

Not covered

Family annual deductible

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

In network

$0

Out of network

Not covered

Coinsurance percentage

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

In network

0%

Out of network

Not covered

Embedded coinsurance maximum

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network

Not covered

Out of network

Not covered

Individual out-of-pocket maximum

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network

$6,500

Out of network

Not covered

Family out-of-pocket maximum

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network

$13,000

Out of network

Not covered

PCP office visit copay

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

In network

$20

Out of network

Not covered

Specialist care copay (when referred)

In network

$50

Out of network

Not covered

Retail health clinic copay

In network

$50

Out of network

Not covered

Urgent care copay

In network

$50

Out of network

Not covered

Emergency room copay

In network

$250

Out of network

Not covered

Ambulance copay (when medically necessary)

In network

$100

Out of network

Not covered

Preferred generic pharmacy copay

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

In network

$10

Out of network

Not covered

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

 $0 Not covered

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

 $0 Not covered

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

 0% Not covered

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

 Not covered Not covered

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

 $6,500 Not covered

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

 $13,000 Not covered

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

 $20 Not covered

$50 Not covered

$50 Not covered

$50 Not covered

$250 Not covered

$100 Not covered

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

 $10 Not covered
THE BLUE CROSS DIFFERENCE

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Network access and solutions

Choices for care

Helping your employees avoid costly ER visits and get the care they need quickly and conveniently.

Value-based care

Elevating the quality of care by rewarding physicians for better patient health outcomes.

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Improved care for healthy employees

Coordinated Care

A care management support program for your employees and their family members who face complex issues.

Health & Well-Being

Encourage a culture of well-being with tools and resources to help your employees improve their whole health.

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Personalized member engagement

Online member account

Your employees will get the tools, information and support they need all under one secure online account.

Blue Cross Rewards

Incentivizing employees to use cost-effective providers by using our “Find Care” tools.

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