2-50 employees

Update

BCN HMO Fixed CostSM

BCN HMO Fixed Cost 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 Blue Care Network HMO Fixed Cost?

2023 Documents

Download 2023 plan certificate

 

2022 Documents

Download 2022 plan certificate

Plan options for 2023

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

N/A

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

$30

Out of network

Not covered

Retail health clinic copay

In network

$30

Out of network

Not covered

Urgent care copay

In network

$30

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.

 N/A 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

$30 Not covered

$30 Not covered

$30 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

$8,500

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

N/A

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

$8,500

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

$17,000

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

$15

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.

 N/A 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.

 $8,500 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.

 $17,000 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.

 $15 Not covered
THE BLUE CROSS DIFFERENCE

See how Smarter, Better Healthcare℠ tackles your small business challenges

Access to care

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

Blue Cross Coordinated Care Core

A care management program for your employees and their family members who face complex health 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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Plan understanding

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 with PPO plans to use cost-effective providers by using our Find Care tools.

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Resources

Pharmacy benefit manager changes

We're moving to a pharmacy benefits management system to keep costs more stable for our group customers and members.

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TOOLKITS

Resources to share with your employees

Browse brochures, videos and posters designed to help your employees get the most out of their Blue Cross coverage.

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