Page 5 - Corporate Dining Concepts BCBC Benefits Guide V2
P. 5
Blue Cross Blue Shield Major Medical Plans (GAP Included)
BCBS Silver $4,000 BCBS $6,350 HDHP
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Service Benefit Service Benefit
$4,000 Single / $6,350 Single /
Deductible Deductible
$8,000 Family $12,700 Family
Coinsurance 20% Coinsurance 0%
Out of Pocket $6,000 Single / Out of Pocket $6,350 Single /
Maximum $12,700 Family
Maximum $12,000 Family
Covered After
Primary Care Visit Primary Care Visit
$30 Deductible
Copay
Covered After
Emergency Room Emergency Room Deductible
$150
Copay Covered After
Urgent Care
Urgent Care Copay $30 Deductible
Rx Copays $10/$40/$80/15% Rx Covered After
Deductible
Please note: These are brief descriptions. Read plan certificates for limitation, exclusions,
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and plan specifics.
