Comparison of coverage options for out-of-state residents |
|||
Coverage |
Aetna Fee-for-Service Plan |
BlueCross Blueshield PPO |
|
In-Network |
Out-of-Network |
||
Monthly Premium |
$44 - retiree only, $88 - retiree +1 |
$351.26 - retiree only, $398.98 - +1 |
|
Deductible (Individual / Family) |
$0 |
$200 / $600 |
$400 / $1,200 |
Office visit |
$15 |
$30 |
40% after deductible |
| Specialist visit | $15 |
$50 |
40% after deductible |
Well woman & well-man exam |
$0 |
$0 |
40% after deductible |
Routine physical |
$0 |
$0 |
40% after deductible |
Inpatient admissions |
$0 |
$500+ 20% |
$1000 + 40% |
Emergency room |
$35 |
$150+ 20% |
$150 + 20% (within 48hrs) |
Ambulance |
$15 |
20% after deductible |
40% after deductible |
Outpatient surgery |
$0 |
20% after deductible |
40% after deductible |
Prescription drugs: Purchase 30-day supply at network pharmacies. |
|||
Generic |
$10 |
$10 |
$10 |
Preferred brands |
$30 |
$30 |
$30 |
| Nonpreferred brands | $45 |
$45 |
$45 |
| Specialty drugs | $45 |
$45 |
$45 |
| Prescription mail-order drugs: Order a 90-day supply for a two-month copayment. | |||