Blue Cross Blue Shield HDHP Maroon Savings Choice
The Maroon Savings Choice Plan is a Preferred Provider Option (PPO) that gives greater control and flexibility on how your health care dollars are spent. It will also provide access to a University-funded, tax advantaged Health Savings Account.
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 medical and prescription drug expenses for the rest of the year. You can compare the Maroon Savings Choice Plan benefits to the other medical plans to determine if it will meet your medical needs.
Your cost for the plan depends on the coverage you select and your income. Enrolling in the plan is limited to certain times or events during your employment.
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.
To find a Blue Cross Blue Shield provider simply visit http://www.bcbsil.com/ and select the Particpating Provider Organization (PPO) plan network.
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.
All non-preventive care will require you to meet 100% of your annual deductible before the plan will provide coverage. For those enrolled with a spouse and/or children, the family deductible must be satisfied before coverage begins for any one family member (often referred to as a "true family" deductible).
The Maroon Savings Choice 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. You pay the full cost of prescription drugs until your annual deductible is met unless it is a preventive drug. Once your annual deductible has been met, then the cost will be the appropriate copay. For preventive drugs, you will only be responsible for the copay before and after your deductible is met. Remember to have the pharmacy apply all CVS Caremark network discount prior to submitting payment.
Participating Retail Pharmacy - For a 30-day supply of preventive drugs (before and after annual deductible is met) and non-preventive drugs (after annual deductible is met)
- 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 of preventive drugs (before and after annual deductible is met) and non-preventive drugs (after annual deductible is met)
- 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 Savings Choice 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 $44 copay per interaction, members can automatically connect with an available doctor or therapist by phone, video conference, and mobile app. Please reference the MDLive flier under Related Documents.