Maroon Plan (PPO)
The Maroon Plan is a Preferred Provider Option (PPO). Each time you need care; you can visit any eligible licensed provider you choose. Generally, you pay the deductible then the plan covers a percentage of the cost of your medically necessary care. Once you reach your out-of-pocket maximum, the plan pays 100% of covered benefits for the rest of the year. You can compare the Maroon Plan benefits to the other medical plans to determine if it will meet your medical needs.
If you visit a network provider, your care is considered “in-network,” and the plan covers a higher percentage of your costs. Your doctor submits your claims directly to the Maroon Plan claims administrator.
If you do not visit a network provider, your care is considered “out-of-network,” and the plan pays less. You file your own claims with the Maroon Plan claims administrator. Plus, if you are admitted to an out-of-network hospital, you must meet an additional $200 deductible before the plan pays benefits. Amounts above the eligible or allowable charges are not covered and do not apply toward your deductible or your out-of-pocket maximum.
In general, routine preventive and wellness medical care will be covered at 100%. Wellness benefits do not count towards your deductible or out-of-pocket maximums.
The Maroon Plan covers prescription drugs and medicines dispensed by a licensed pharmacist or physician with a written prescription at a participating pharmacy or through the mail order program. Drugs must be approved by the U.S. Food and Drug Administration for general use by humans, including oral contraceptives.
Participating Retail Pharmacy - For a 30-day supply
- Generic - 100% after $10 Copayment
- Preferred brand-name - 100% after $30 Copayment
- Non-Preferred brand-name - 100% after $45 Copayment
- Specialty - 100% after $75 Copayment
Mail Order - For 90-day supply
- Generic - 100% after $20 Copayment
- Preferred Brand-name - 100% after $60 Copayment
- Non-Preferred brand-name - 100% after $90 Copayment
Effective January 1, 2017, Telemedicine will allow Maroon members to receive care without the time and stress of traveling to an appointment. Through MDLIVE, members will have access to care for non-emergency medical issues and behavioral health needs. MDLIVE doctors or therapists can help treat the following conditions and more: allergies, asthma, nausea, sinus infections, cold, flu, ear problems, pink eye, anxiety/depression, child behavior/learning issues, and marriage problems.
For a $40 copay per interaction, members can automatically connect with an available doctor or therapist by phone, video conference, and mobile app. Learn more about this benefit in the MDLive flier under Related Documents. Step-by-step instructions on how to register for MDLive and how to schedule a telemedicine appointment can be found at http://bcbsil.csdesignpro.com/virtual_visits/.