Page 10 - Winsight 2021 Benefit Guide

Which type of plan is right for you?

Blue Cross HDHP
Blue Cross PPO Blue Cross PPO
Plan ($500/$1,500 Plan ($1,500/$4,500 Plan With HSA Blue Cross HMO
(No Deductible)
($3,500/$7,000
Deductible) Deductible)
Deductible)
Employee has the Employee has the Employee has the
flexibility to use any flexibility to use any flexibility to use any Employee may only
provider, however, provider, however, provider, however, use providers that
electing providers in the electing providers in the electing providers in the participate in the local
Availablity of BluePrint PPO network BlueEdge HSA network Blue Advantage HMO
Network Cost BluePrint PPO network will require lower or no will require lower or network. If you use
Share will require lower or no
cost-share. If you use cost-share. If you use no cost-share. If you out-of-network providers,
out-of-network providers, out-of-network providers, use out-of-network these services will not be
a higher cost-share will a higher cost-share will providers, a higher cost- covered.
result. result. share will result.

The employee pays
The employee pays The employee pays higher deductible and The employee only pays
Out-of-Pocket deductible and copays deductible and copays prescription copays copays until the out-of-
Expenses until the out-of-pocket until the out-of-pocket until the out-of-pocket pocket maximum is met.
maximum is met. maximum is met.
maximum is met.
Referral Required No No No Yes
for Specialist
Eligibility for FSA Yes Yes No Yes

Eligibility for Health
Savings Account No No Yes No
(HSA)

Eligible in-network Eligible in-network Eligible in-network Eligible in-network
preventive care services preventive care services preventive care services preventive care services
Preventive Care are covered at 100%; are covered at 100%; are covered at 100%; are covered at 100%;
no copay, deductible or no copay, deductible or no copay, deductible or no copay, deductible or
coinsurance applies. coinsurance applies. coinsurance applies. coinsurance applies.

You pay the discounted
Primary Care and cost of visits until
Specialist Office You pay a copay for office You pay a copay for office deductible is met, You pay a copay for
Visits visits. visits. then coinsurance office visits.
applies
You pay the discounted
You pay the You pay the cost of hospital stay until
Inpatient Hospital deductible. Then deductible. Then deductible is met, You pay nothing.
coinsurance applies. coinsurance applies. then coinsurance
applies

You pay the
Emergency Room You pay copay. You pay copay. deductible. Then the You pay copay.
coinsurance applies.

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