BLUECHOICE HEALTHCARE PLAN (HMO)
Columbus Consolidated Government

CHOICE OF PROVIDER

BlueChoice Healthcare Plan Hospitals & Doctors

Annual Deductible

No deductible

Annual Out-of-Pocket Maximum (excluding co-payments)

$1,000 Employee
$2,000 Family

Lifetime Maximum

Unlimited

OFFICE SERVICES

 

Primary Care Physician (PCP) Office Visit

You pay a $15.00 co-payment per visit

Specialty Care Physician (SCP) Office Visit

You pay a $25.00 co-payment per visit

Annual Gynecological Exam by PCP

You pay a $20.00 co-payment per visit

Annual Gynecological Exam by SCP

You pay a $25.00 co-payment per visit

Maternity Services (Physician Care per Pregnancy


You pay a $25.00 co-payment per visit

Mammograms

Included in office visit co-payment

Pap Smear

Included in office visit co-payment

Prostate Screening

Included in office visit co-payment

Periodic Health Assessment

You pay a $20 co-payment per visit

Flu Shots

Included in office visit co-payment

Well Baby Care

You pay a $20 co-payment per visit

Immunizations

Included in office visit co-payment

INPATIENT SERVICES/OUTPATIENT SERVICES

Semi-Private Room, Board and Other Covered Services


Plan Pays 90%

Maternity and Newborn Care

Plan Pays 90%

Doctor Visits

Plan Pays 100%

EMERGENCY SERVICES (EMERGENCY ROOM)

Medical emergencies are paid at 100% after emergency room co-payment.  No benefits for non-emergency visit to the emergency room.



You pay a $50 co-payment per visit

OTHER SERVICES

Prescription Drugs

You pay a $20 co-payment for generic, $30.00 for brand name and $50.00 for non-formulary per prescription for a 30 day supply.

Mail Order Prescription Drugs
    Long-term or maintenance medication

You pay a $40 co-payment for generic, $60.00 for brand name and $100.00 for non-formulary  per prescription for a 90 day supply from PrecisionRX

MENTAL HEALTH/SUBSTANCE ABUSE

Inpatient 30 days per year

Plan Pays 90%

Outpatient 5- visits per year

 

NON-COVERED SERVICES

 

Chiropractic Services

Not Covered

 

This outline is designed only to provide a summary of benefits.
The particulars set forth within the master contract will control.

 

Home | Affirmative Action | Employee Benefits | Organizational Chart | Health Insurance
 Job Opportunities | Contact Us | FAQ | GovJobs.com