if your annual base salary is: $75,000 or less | if your annual base salary is: more than $75,000 | |||
---|---|---|---|---|
Employee-Only Coverage | Other Coverage Levels | Employee-Only Coverage | Other Coverage Levels | |
BMC Flat Seed | $200 in January and July for a total of $400 | $0 | $0 | |
BMC matches your contributions1 | Up to $350 | Up to $1,100 | Up to $500 | up to $1,000 |
BMC will match your HSA contributions each pay period in 2025 | ||||
Your contribution limit | Up to $3,550 | Up to $7,050 | Up to $3,800 | Up to $7,550 |
Total 2025 Contribution2 allowed by the IRS (yours and BMC's) | $4,300 | $8,550 | $4,300 | $8,550 |
in-network | out-of-network | |
---|---|---|
Annual Deductible | $1,850 single/$3,700 all other coverage levels | $3,700 single/$7,400 all other coverage levels |
Annual Out-of-Pocket Maximum (includes deductible and copays) | $3,700 single / $7,400 all other coverage levels | $7,400 single / $14,800 all other coverage levels (excludes amounts above usual and customary) |
Lifetime Maximum Benefit | Unlimited | Unlimited |
General Medical Expenses | ||
Primary & Specialist Doctor Office Visit (includes maternity care) | 85% covered after deductible | 65% covered after deductible |
MDLIVE Physician3 | $48 | Not applicable |
Inpatient Hospital Care (requires preauthorization) | ||
Hospitalization4 | 85% covered after deductible | 65% covered after deductible |
Inpatient Physician and Surgeon Services4 | 85% covered after deductible | 65% covered after deductible |
Inpatient Lab and X-ray5 | 85% covered after deductible | 65% covered after deductible |
Maternity and Delivery Services & Newborn Nursery Services6 | 85% covered after deductible | 65% covered after deductible |
Outpatient Care | ||
Outpatient Surgery | 85% covered after deductible | 65% covered after deductible |
Outpatient Laboratory Services & X-ray Services5 | 85% covered after deductible | 65% covered after deductible |
Preventative Care | ||
Annual Physical Exam & Immunizations | 100% covered per exam (no deductible applies) | 65% covered after deductible |
Well-Baby & Well-Child Exams and Immunizations | 100% covered per exam (no deductible applies) | 65% covered after deductible |
Well-Woman Exam | 100% covered per exam (no deductible applies) | 65% covered after deductible |
Other Preventive Care & Cancer Screenings7 | 100% covered per exam (no deductible applies) | 65% covered after deductible |
Emergency Services | ||
Hospital Emergency Facility | 85% covered after deductible | 85% covered after deductible |
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 deductible |
Chiropractic Services | ||
Spinal Manipulation | 85% covered after deductible Maximum of 25 visits each calendar year (in-and out-of-network services combined) | 65% covered after deductible Maximum of 25 visits each calendar year (in-and out-of-network services combined) |
Short-Term Rehabilitation Therapy8 | ||
Outpatient Physical, Speech, Occupational Therapy | 85% covered after deductible; 60-visit combined maximum per year | 65% covered after deductible; 60-visit combined maximum per year |
Mental Health, Substance Abuse Care | ||
Mental Health: Inpatient & Outpatient Coverage | 85% covered after deductible | 65% covered after deductible |
Rehab and Detox: Inpatient & Outpatient Coverage | 85% covered after deductible | 65% 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 | 65% covered after deductible |
MDLIVE® Behavioral Therapy | $80 to $175 per consultation before deducible depending on provider selected; 85% covered after deductible | Not applicable |
Other Benefits | ||
Condition Management | 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 Prime Therapeutics, an affiliate of BCBSTX. | |
Health Savings Account | You will have a Health Savings Account opened for you through Fidelity. BMC deposits employer contributions, and you may choose to deposit your own contributions into this account. |