Comparing BMC Medical Plans

Here is a Snapshot of the Medical Plan Choices

BCBSTX HSA
BCBSTX PPO
KAISER HMO
You Receive Care From: Any provider you choose; in-network services cost you less Any provider you choose; in-network services cost you less Providers in the network
Claim Forms and Paperwork Are Filed By: In-Network: Your doctor
Out-of-Network: You
In-Network: Your doctor
Out-of-Network: You
In-Network: Your provider
Managing Your Health You coordinate your care You coordinate your care Primary care physician coordinates care with you
Out-of-Area Participant Coverage Yes Yes Emergencies only—check with plan
Your Cost Share Your monthly premium is lower, but you pay for all medical services (except preventive) and prescription drug costs (except 15% of certain preventive prescription drugs) until you reach the deductible. After you reach the deductible, the cost is shared between BMC and you. Your monthly premium is higher; you only pay a copay for doctor’s visits and prescription drugs. Certain services are subject to a deductible, and then the cost is shared between BMC and you. Your monthly premium is higher; you only pay a copay for most services.
Health Savings Account (HSA) A Health Savings Account is automatically opened for you. You receive employer contributions, and you may make your own before-tax payroll contributions up to the annual IRS limit. Not eligible to participate Not eligible to participate
Health Care Flexible Spending Account (FSA) You may make before-tax contributions to a Limited Use FSA for dental and vision care. After you have reached your deductible, you may also receive reimbursement for medical claims incurred after that date. You may make before-tax contributions to a Health Care Flexible Spending Account for all eligible health expenses allowed by the IRS Publication 502. You may make before-tax contributions to a Health Care Flexible Spending Account for all eligible health expenses allowed by the IRS Publication 502.

BMC National Medical Plans

The amounts in the chart below are for in-network services only. If you go out of network, your amounts will be different.

BCBSTX HSA
BCBSTX PPO
Annual Deductible $1,500 single/$3,000 all other coverage levels $750 single/$1,500 all other coverage levels
Annual Out-of-Pocket Maximum (includes deductible and copays) $3,000 single/$6,000 all other coverage levels $3,000 single/$6,000 all other coverage levels
Lifetime Maximum Benefit Unlimited Unlimited
General Medical Expenses
Primary Doctor Office Visit 85% covered after deductible $25 copay
MDLIVE Physician1 $44 $44
Specialist Doctor Office Visit 85% covered after deductible $40 copay
Inpatient Hospital Care (requires preauthorization)
Hospitalization2 85% covered after deductible 85% covered after deductible
Inpatient Physician and Surgeon Services2 85% covered after deductible 85% covered after deductible
Inpatient Lab and X-ray3 85% covered after deductible 85% covered after deductible
Maternity and Delivery Services & Newborn Nursery Services4 85% covered after deductible
Outpatient Care
Outpatient Surgery 85% covered after deductible 85% covered after deductible; if performed as a part of an office visit and billed by a physician applicable copay applies
Outpatient Laboratory Services & X-ray Services3 85% covered after deductible 85% covered after deductible; if performed as part of an office visit and billed by a physician applicable copay applies
Preventive Care
Annual Physical Exam & Immunizations 100% covered per exam (no deductible applies) 100% covered
Well-Baby & Well-Child Exams and Immunizations 100% covered per exam (no deductible applies) 100% covered
Well-Woman Exam 100% covered per exam (no deductible applies) 100% covered
Other Preventive Care & Cancer Screenings5 100% covered per exam (no deductible applies) 100% covered
Maternity Care5
Office Visit: Prenatal/Postnatal $25 copay, initial visit only
In-Hospital Delivery & Newborn Nursery Services 85% covered after deductible
Emergency Services
Hospital Emergency Facility 85% covered after deductible 85% covered after deductible and after $250 copay
Non-Emergency Care in a Hospital Emergency Room Not covered Not covered
Urgent Medical Care (at a non-hospital free standing facility) 85% covered after deductible 85% covered after $40 copay
Non-Urgent Use of Urgent Care Provider (at a non-hospital free standing facility) 85% covered after deductible
Chiropractic Services
Spinal Manipulation 85% covered after deductible
Maximum of 25 visits each calendar year (in-and out-of-network services combined)
Short-Term Rehabilitation Therapy6
Outpatient Physical, Speech, Occupational Therapy 85% covered after deductible; 60-visit combined maximum per year 85% covered after deductible; 60-visit combined maximum per year
Mental Health, Substance Abuse Care
Mental Health: Inpatient & Outpatient Coverage 85% covered after deductible $25 copay
Rehab and Detox: Inpatient & Outpatient Coverage 85% covered after deductible 85% covered after deductible
Residential Treatment Facility (stays in a residential treatment facility for treatment of mental disorders, alcoholism or drug abuse) 85% covered after deductible 85% covered after deductible
MDLIVE® Behavioral Therapy $80 to $175 per consultation before deducible depending on provider selected; 85% covered after deductible $44
Other Benefits
Condition Management BCBSTX Condition Management programs offer support for people diagnosed with chronic conditions such as asthma, diabetes, heart problems and others. BCBSTX Condition Management programs offer support for people diagnosed with chronic conditions such as asthma, diabetes, heart problems and others.
Prescription Drugs Prescription Drugs are covered through Express Scripts and not through BCBSTX. Please see Prescription Drugs for more information. Prescription Drugs are covered through Express Scripts and not through BCBSTX. Please see Prescription Drugs for more information.
Health Savings Account You will have a Health Savings Account opened for you through UMB Bank. BMC deposits employer contributions, and you may choose to deposit your own contributions into this account. Please see Health Savings Account for more information.

(1) Your payments to MDLIVE do not count toward the in-network deductible and out-of-pocket maximums for the HSA and PPO medical plans.

(2) The plan covers bariatric surgery, knee and hip replacements, select spine surgeries and some transplants if performed at a Blue Distinction Center.

(3) Certain high-tech radiology tests (CT scans and MRIs) require prior authorization except during a medical emergency. Authorization is not required for low resolution diagnostic services, including mammograms, sonograms, and x-rays.

(4) Your newborn is automatically covered under the plan for the first 31 days after the date of birth. If you wish to continue coverage for the newborn beyond that date, you must add the child to your medical coverage through the My BMC Compensation & Benefits website (select the Life Changes tab) within 31 days after the newborn’s date of birth.

(5) Other preventive exams and cancer screenings may have age and time limit restrictions.

(6) Additional plan authorization review required after 30 days.

Important: Other limitations may apply. If you have questions about the PPO or HSA medical plans or need more information, take a look at the plan documents on  the My BMC Compensation & Benefits website (click on the Plan Documents tile.)