Page 4 - 2021 TMED Benefit Guide
P. 4
Medical Options:
Blue Cross Blue Shield
Per Pay Period Core Buy-Up Dependent Information
Bi-Weekly 2021
Monitoring Concepts offers employees the opportunity
Employee Only $ 48.12 $ 91.51
to cover their dependent children. Children can join or
Employee + Spouse $144.38 $221.15 remain on a parent’s medical plan until age 26.
Employee + Child(ren) $157.04 $254.19 When a child turns 26, they will lose medical coverage
on the last day of their birth month.
Employee + Family $253.29 $366.04
PPO Core Plan PPO Buy-Up Plan
In-Network Benefits $3,000 Deductible $1,500 Deductible
In and OUT of Network Coverage In and OUT of Network Coverage
Calendar Year Deductible (CYD) Individual: $3,000 Individual: $1,500
January 1st to December 31st Family: $9,000 Family: $4,500
Coinsurance Carrier 90% / Member 10% Carrier 100% / Member 0%
Out of Pocket Maximum: Individual: $7,900 Individual: $4,500
(Includes CYD, Copays, Co-Ins) Family: $15,800 Family: $13,500
Office Visit - PCP $30 Copay $30 Copay
Office Visit—Specialist $60 Copay $60 Copay
Telemedicine 24/7 (MDLive) $30 Copay $30 Copay
COVID-19 Coverage (during COVID Paid 100% for Testing & Vaccine Paid 100% for Testing & Vaccine
pandemic)
Preventive Care Covered 100% Covered 100%
Lab Work & X-Rays (Basic) Covered 100% Covered 100%
(Imaging) MRI’s, CT, PET 10% After CYD Covered 100% After CYD
Urgent Care $75 Copay $75 Copay
Emergency Room $500 Copay, plus 10% After CYD $500 Copay, After CYD
Hospitalization (Inpatient) 10% After CYD Covered 100% After CYD
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Preferred Generic:$0/$10 erred Generic:$0/$10
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IN-NETWORK Non-Preferred Generic:$20/$30 Non-Preferred Generic:$20/$30
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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