2-50 employees

Update

Blue Elect PlusSM Self-Referral Option HMO

This self-referral option has comprehensive coverage through BCN, allowing your employees to seek care from in and out-of-network providers without a referral. In 2021, we're improving this plan offering by updating it to Blue Elect Plus POS.

Plan highlights
  • Employees can get care wherever they want without the need for a referral.
  • Prescription drug coverage is included. 
  • Preventive care is 100% covered.

NETWORK SIZE

Network Size

PREMIUM COST

$$$$

LEVEL OF CONSUMER ENGAGEMENT

Low

INDIVIDUAL DEDUCTIBLE

$1,000

HOW SELF-REFERRAL PLANS WORK

In an HMO plan, members typically rely on their primary care physician for referrals. Blue Elect Plus HMO, however, offers a unique self-referral option that sets it apart. 

Here's why:

  • It gives your employees the freedom to see any doctor or specialist without a referral.
    • Your employees will pay the least when they get care from a doctor in our network. 
    • They’ll pay the most when the doctor doesn’t belong to our network.
    •  It’s up to your employees to decide what works best.
    • Even though a referral isn’t required, certain in- and out-of-network services will still require prior approval.
Want more details about Blue Elect Plus Self-Referral Option HMO?

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Plan options for 2020

Gold $1,000

This is a mid-level plan with a $1,000 deductible.

Monthly premium

Medium

Deductible

$1,000

Out-of-pocket maximum

$7,350

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

$1,000

Out of network

$2,000

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

$2,000

Out of network

$4,000

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

20%

Out of network

40%

Individual 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

$3,500

Out of network

$7,000

Family 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

$7,000

Out of network

$14,000

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

$7,350

Out of network

$14,700

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

$14,700

Out of network

$29,400

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

40% after deductible

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

$10

Individual annual deductible

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

 $1,000 $2,000

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. 

 $2,000 $4,000

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.

 20% 40%

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.

 $3,500 $7,000

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.

 $7,000 $14,000

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.

 $7,350 $14,700

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.

 $14,700 $29,400

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 40% after deductible

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 $10
THE BLUE CROSS DIFFERENCE

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

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Frequently asked questions

Our agents can help you set up your plan, enroll your employees and help you determine the easiest way to set up payments. Contact an agent to learn more. 

There are three types of accounts used to pay for medical expenses: a health savings account, or HSA, a health reimbursement arrangement, or HRA, and a flexible spending account, also known as an FSA.

These accounts are part of what's called consumer-directed health care. They offer:

  • Potential tax savings by being tax exempt or tax deductible
  • More control over health care costs
  • Lower health care costs

We can help you decide which is best for your business and employees. Connect with us.

PCP Focus is a custom primary care physician HMO network offered by Blue Care Network. The doctors your employees will choose from this network have shown they can provide quality care and a high level of efficiency that lowers health care costs. We pass those savings on to you: your premiums are up to 8% lower when you choose a plan with the PCP Focus network.

Interested in this plan for your employees?

Let us help you choose the plans that meet your strategic goals.

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