Page 4 - TMED 2023 Benefit Guide
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Medical Options:
Blue Cross Blue Shield
Per Pay Period Core Buy-Up Dependent Information
Bi-Weekly 2023
Monitoring Concepts offers employees the opportunity
Employee Only $ 85.00 $ 130.00
to cover their dependent children. Children can join or
Employee + Spouse $145.00 $225.00 remain on a parent’s medical plan until age 26.
Employee + Child(ren) $295.00 $410.00 When a child turns 26, they will lose medical coverage
on the last day of their birth month.
Employee + Family $360.00 $485.00
PPO Core Plan PPO Buy-Up Plan
In-Network Benefits $3,000 Deductible $2,000 Deductible
In and OUT of Network Coverage In and OUT of Network Coverage
Calendar Year Deductible (CYD) Individual: $3,000 Individual: $2,000
January 1st to December 31st Family: $9,000 Family: $6,000
Coinsurance Carrier 80% / Member 20% Carrier 80% / Member 20%
Out of Pocket Maximum: Individual: $8,150 Individual: $5,000
(Includes CYD, Copays, Co-Ins) Family: $16,300 Family: $14,700
Office Visit - PCP $35 Copay $30 Copay
Office Visit—Specialist $70 Copay $60 Copay
Telemedicine 24/7 (MDLive) $35 Copay $30 Copay
Preventive Care Covered 100% Covered 100%
Lab Work & X-Rays (Basic) Covered 100% Covered 100%
(Imaging) MRI’s, CT, PET 20% After CYD 20% After CYD
Urgent Care $75 Copay $75 Copay
Emergency Room $500 Copay, plus 20% After CYD $500 Copay, plus 20% After CYD
Hospitalization (Inpatient) 20% After CYD 20% After CYD
Preferred Generic:$0/$10 erred Generic:$0/$10
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IN-NETWORK Non-Preferred Generic:$10/$20 Non-Preferred Generic:$10/$20
Participating Pharmacies / Non Preferred Name Brand: $50/$70 Preferred Name Brand: $50/$70
Participating Pharmacies Non-Preferred Brand: $100/$120 Non-Preferred Brand: $100/$120
Prescription Drugs 30 Day Supply Mail Specialty Preferred:$150 Specialty Preferred:$150
Order 3 X the retail Participation copay
Specialty Non Preferred:$250 Specialty Non Preferred:$250
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