Review Your Benefit Options

Medical Benefits

Overview

You have three medical plan options: the Premier Plan, the Value Plus Plan and the Value Plan. All plans are administered by BlueCross BlueShield (BCBS) and provide the maximum benefits when a BCBS provider is used for services.

The ALVMA Value Plus Plan includes both primary and secondary insurance. The secondary plan does not cover office visits or prescription drug copays or home health services.

NOTE: The out-of-pocket maximum excludes office visits and prescription drug co-pays.

	Premier Plan	Value Plus Plan (Includes Secondary)	Value Plan
	In-Network	In-Network	In-Network
Deductible Individual Family Coinsurance	$1,000 $2,000 100%	$1,000 $2,000 80%	$4,000 $8,000 80%
Out-of-pocket Max. Individual Family	$6,000 $12,000	$1,800 $3,600	$6,800 $13,600
Inpatient Services Inpatient Facility	Covered at 100% after $250 per day copay (days 1-5)	20% Coinsurance	20% Coinsurance
Emergency Room	Covered at 100% after $250 copay	20% Coinsurance	20% Coinsurance
Physician Office Visits Preventative Care Primary Care Specialist Office	100% Covered $40 Copay $60 Copay	100% Covered $45 Copay $65 Copay	100% Covered $45 Copay $65 Copay
Outpatient Services Outpatient Surgical	Covered at 100% after $250 copay	20% Coinsurance	20% Coinsurance
Diagnostic X-Ray Lab	Covered at 100% after $250 copay	20% Coinsurance	20% Coinsurance
Mental Health / Substance Abuse	Covered at 100% after $250 copay	20% Coinsurance	20% Coinsurance
Prescriptions Tier 1 Tier 2 Tier 3 Tier 4	$15 Copay $50 Copay $100 Copay $395 Copay	$15 Copay $60 Copay $100 Copay $425 Copay	$15 Copay $60 Copay $100 Copay $425 Copay

Medical Plan Rates (Monthly)

Coverage Tier	Premier Plan	Value Plus Plan	Value Plan
Employee Only	$691.49	$606.85	$531.32
Employee + Spouse	$1,442.36	$1,264.48	$1,102.80
Employee + Children	$1,171.15	$1,039.18	$897.26
Family	$2,034.47	$1,764.23	$1,553.96