Page 3 - Lansing Regional Chamber of Commerce Booklet

LRCC

Group Benefit Offerings

BCN HMO PCP Focus Platinum - $500

$500/$1000 per family deductible followed by 100% coinsurance to an
out-of-pocket maximum of $1500/$3000 per family per calendar year,
$20 PCP Office Visit Copay, including Online Visits, $30 Specialist Copay,
$35 Urgent Care Copay, $150 Emergency Room Copay after deductible,$4
Generic (Tier A)$15 Generic (Tier B)/$40 Preferred Brand Name/$80 Non-
Preferred Brand Name/20% Specialty Preferred/20% Non-Preferred
Specialty Prescription Drug Copays

BCN HMO PCP Focus Gold - $1000

$1000/$2000 per family deductible followed by 80% coinsurance to an
embedded out-of-pocket maximum of $3500/$$7000 then to an overall
maximum of $8150/$16,300 per family per calendar year, $20 PCP Office
Visit Copay, including Online Visits, $40 Specialist Copay, $50 Urgent Care
Copay, $250 Emergency Room Copay after deductible,$10 Generic (Tier
A)$30 Generic (Tier B)/$60 Preferred Brand Name/$80 Non-Preferred
Brand Name/20% Specialty Preferred/20% Non-Preferred Specialty
Prescription Drug Copays

No one is currently enrolled – Rate Grid is available

BCSBM Dental

This plan covers 100% of Preventative Services, 80% Basic Services, 50%
Major Services, and 50% Orthodontics. Each person on the plan has
$1000 of annual benefit and a $1000 lifetime benefit for Orthodontics.
$25/$75 per family deductible applies to Basic and Major Services only.

BCBSM Vision (VSP)
This plan covers an Eye Exam and Materials to a $130 allowance once
every 12 months. Copays: $5 Eye Exam, $10 for Materials.