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 2021.
Your contribution limit Up to $2,850 Up to $5,700 Up to $3,100 Up to $6,200
Total 2021 Contribution2 allowed by the IRS
(yours and BMC's)
$3,600 $7,200 $3,600 $7,200
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 $44 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
Preventive 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 Therapy 8
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 Express Scripts and not through BCBSTX.
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.