Page 5 - Recaro North America Benefits Guide
P. 5
RECARO North America Medical Plan Options
Blue Cross Blue Shield
BCBS PPO Gold $1,500 BCBS PPO Gold $2,000 HDHP BCBS PPO Silver $3,500 HDHP
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Service Benefit Service Benefit Service Benefit
$1,500 per $2,000 per $3,500 per
member / member / member /
Deductible Deductible Deductible
$3,000 for $4,000 for $7,000 for
family family family
Coinsurance 20% - $1,000 Coinsurance 0% Coinsurance 0%
$6,600 per $3,000 per $5,500 per
Out of Pocket member / Out of Pocket member / Out of Pocket member /
Maximum $13,200 for Maximum $6,000 for Maximum $11,000 for
family family family
Primary Care Primary Care 100% After Primary Care 100% After
$20
Visit Copay Visit Copay Deductible Visit Copay Deductible
Emergency Emergency 100% After Emergency 100% After
$150
Room Visit Room Visit Deductible Room Visit Deductible
Urgent Care Urgent Care 100% After Urgent Care 100% After
$60
Copay Copay Deductible Copay Deductible
$15/$50/$70/ $20/$60/$80/ $20/$60/$80/
Rx Rx (DED First) Rx (DED First)
$200 $230 20% max $200
Please note: These are brief descriptions. Read plan certificates for limitation, exclusions, and 5
plan specifics.
