Medical Coverage - In-Network Coverage

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» Resources
» Rates
» Network
» Plan Year Out-of-Pocket Maximum
» Primary Care Services
» Specialist Physician Services
» Urgent Care Services
» Emergency Room Services
» Plan Year Deductible
» Co-Insurance
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Additional Coverage Details:

» Prescription Coverage
» Preventive Services
» Out of Network Coverage
» MDLIVE - Telehealth
» CatapultHealth - Health Screenings
» Benefits Value Advisor
» ConnectDME - Medical Equipment
» Dependent Deductible Reimbursement
» Dependent Accident Reimbursement
» Medical Claim Reimbursement Form
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Resources

» Provider Search: Click Here
» Video: Watch
» Out of Network Claim Form: Click Here
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Monthly Rates (for Active Employees)

   511.86  Employee Only
1,070.00  Employee & Spouse
   761.28  Employee & Child
   917.88  Employee & Children
1,119.90  Employee, Spouse & Child
1,301.38  Employee, Spouse & Children
» Premium Rates for all Coverage Lines: Click Here
» Contact Us for Retiree, COBRA or Disability COBRA Rates
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Network

BluePreferred
» from BlueCross BlueShield of Oklahoma
» 90% of Oklahoma Providers are In-Network
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Plan Year Out-of-Pocket Maximum

2,500
» $7,500 Maximum for a Family of 3 or More
» No Lifetime
» No Plan Year Limits
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Out-of-Pocket Maximum is Reached with any Combination of the Following:

Primary Care Physician Services

20 Office Visit Co-Pay
» Co-Pay Counts Towards the Annual Out-of-Pocket Maximum
» Non Office Visit Services are Subject to Deductible & Co-Insurance
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Specialist Physician Services

50 Office Visit Co-Pay
» Co-Pay Counts Towards the Annual Out-of-Pocket Maximum
» Non Office Visit Services are Subject to Deductible & Co-Insurance
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Urgent Care Services

20 per Visit Co-Pay
» Co-Pay Counts Towards the Annual Out-of-Pocket Maximum
» Non Office Visit Services are Subject to Deductible & Co-Insurance
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Emergency Room Services

Subject to Plan Year Deductible & Co-Insurance after $ 50 per Visit Fee
» Per Visit Fee Waived if Visit is for Emergency Services
» Per Visit Fee Waived if Individual is Admitted
» Per Visit Fee Counts Towards the Annual Out-of-Pocket Maximum
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Plan Year Deductible

750
» Counts Towards the Annual Out-of-Pocket Maximum
» $2,250 Maximum for a Family of 3 or More
» $250 Employee & Spouse Deductible Reduction: Learn More
» $375 Dependent Deductible Reimbursement: Learn More
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Co-Insurance

20 %
» Member Paid of Allowable Charges After Plan Year Deductible
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