New health insurance rates have been set. You will see these new rates reflected in your February 18 paycheck.
Here are the details:
Health Insurance – Blue Cross Blue Shield HMO Blue NE w/2000 with HCCS and 4-tier RX plan.
Dental Insurance – Blue Cross Blue Shield Dental Blue
Vision Insurance – Blue Cross 20/20
Effective February 1, 2021 through January 31, 2022
Blue Cross Blue Shield HMO Blue NE 2000 Hospital Choice Cost Sharing* | ||
PCP Office | $25 per visit | |
Preventative Care | $0 | |
Specialist Office Visit or Chiropractor Visit | $40 per visit | |
Labs, Diagnostic, X-ray, Including CT scans, MRIs, PET scans & Nuclear cardiac imaging | Deductible, then 100%* | |
Emergency Room | $150 per visit | |
Inpatient Hospital Co-pay Surgical Day Care (Outpatient surgery) | Deductible, then 100%* | |
Annual Deductible Individual / Family | $2,000 / $4,000 | |
Prescription Drugs | ||
Rx Deductible (calendar yr.) | $0 | |
Generic / Preferred / Non-Preferred | $20/$40/$60/$120 | |
Mail Order (90 days) | $40/$80/$120/$360 | |
Out-of-Pocket Limit | ||
Individual Out-of-Pocket Max. | $4,000 | |
Family Out-of-Pocket Max. | $8,000 |
*additional fees may apply if you receive services at a higher cost hospital
RATES
Health Insurance | Dental Insurance | Vision Insurance | |||
Individual | $130.77 | Individual | $6.36 | Individual | $3.42 |
Emp + 1 | $5.81 | ||||
Emp + Children | $5.98 | ||||
Family | $343.01 | Family | $18.97 | Family | $9.40 |