Health
We are proud to offer you a choice between three different medical plans that provide comprehensive medical and prescription drug coverage. The plans also offer many resources and tools to help you maintain a healthy lifestyle. Following is a brief description of each plan.
Medical Plans
The High-Deductible Health Plan (HDHP) gives you the freedom to seek care from the provider of your choice. You will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the BCBS network. In addition, the HDHP comes with a health savings account (HSA) that allows you to save pre-tax dollars* to pay for any qualified health care expenses as defined by the IRS, including most out-of-pocket medical, prescription drug, dental and vision expenses.
View list of eligible health care expenses (PDF)
In-Network Urgent Care Centers (PDF)
* Tax free under federal tax law (state taxation rules may apply).
Here’s how the HDHP with HSA Plan works:
- Annual Deductible: You must meet the entire annual deductible before the plan starts to pay for non-preventive medical and prescription drug expenses. NOTE: If you enroll one or more family members, you must meet the full FAMILY deductible before the plan starts to pay expenses for any one individual.
- Coinsurance: Once you’ve met the plan’s annual deductible, you are responsible for a percentage of your medical expenses, which is called coinsurance. For example, the plan may pay 80 percent and you may pay 20 percent.
- Annual Out-of-Pocket Maximum: Once your deductible and coinsurance add up to the plan’s annual out-of-pocket maximum, the plan will pay 100 percent of all eligible covered services for the rest of the calendar year. NOTE: If you enroll one or more family members, you must meet the full FAMILY out-of-pocket maximum before the plan starts to pay covered services at 100 percent for any one individual.
- Health Savings Account (HSA): You may contribute to your HSA through pre-tax payroll deductions to help offset your annual deductible and pay for qualified health care expenses. In addition, we will contribute $1,500 annually to your HSA if you enroll in employee-only coverage and $2,000 annually if you enroll yourself and one or more family members. To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B or TRICARE programs. See the plan documents for full details.
Important: Your contributions, in addition to the company’s contributions, may not exceed the annual IRS limits listed below.
| IRS Contribution Limits | 2020 | 2021 | 2022 |
| Employee Only | $3,550 | $3,600 | $3,650 |
| Family | $7,100 | $7,200 | $7,300 |
| Catch-up (ages 55+) | $1,000 | $1,000 | $1,000 |
Your HSA is yours for life. The money is yours to spend or save, regardless of whether you change health plans,* retire or leave the company. There is no “use it or lose it” rule. Your account grows tax free over time as you continue to roll over unused dollars from year to year. You decide how or if you want to spend your HSA funds. You can use it to pay for you and your dependents’ doctor’s visits, prescriptions, braces, glasses—even laser vision correction surgery.
*You must be enrolled in a qualified health plan to contribute to an HSA.
Your contributions toward the cost of medical coverage are automatically deducted from your paycheck before taxes.
| HDHP with HSA - Medical Rates | |
| Coverage | Minimum Employee Cost Share** |
| Employee | $0.00 |
| Employee + Spouse | $135.74 |
| Employee + Child(ren) | $106.42 |
| Family | $228.05 |
*Maximum Employee Cost Share reflects that the employee and/or spouse chose not to complete a health risk assessment (HRA).
**Minimum Employee Cost Share reflects that employee and spouse (if applicable) completed their HRA.
Please note: There may be slight variations in cost between the Maximum and Minimum Cost Share shown here based on HRA completion. For a better understanding of that calculation, please reach out to your City HR team.
BCBS HDHP with HSA Plan Summary of Benefits and Coverage (SBC) (PDF)
| BCBS HDHP / HSA Key Medical Benefits | In-Network | Out-of-Network |
|---|---|---|
| Deductible (per calendar year) | ||
| Individual / Family | $2,800 / $5,200 | $5,200 / $10,600 |
| Out-of-Pocket Maximum (per calendar year) | ||
| Individual / Family | $5,200 / $10,600 | $10,600 / $20,000 |
| Company Contribution to Your Health Savings Account (HSA) | ||
| Individaul / Family | $1,500 / $2,000 | $1,500 / $2,000 |
| Covered Services | ||
| Office Visits (physician / specialist) | 20% | 50% |
| Routine Preventive Care | No charge | 50% |
| Outpatient Diagnostic (Lab / X-ray) | 20% | 50% |
| Complex Imaging | 20% | 50% |
| Chiropractic | 20% | 50% |
| Ambulance | 20% | 50% |
| Emergency Room | 20% | 50% |
| Urgent Care Facility | 20% | 50% |
| Inpatient Hospital Stay | 20% | 50% |
| Outpatient Surgery | 20% | 50% |
| Prescription Drugs (Tier 1a / Tier 1b / Tier 2 / Tier 3 / Tier 4 | ||
| Retail Pharmacy (30-day supply) | Must meet deductible. Then copay applies | Must meet deductible. Then copay applies |
| Mail Order (90-day supply) | Must meet deductible. Then copay applies | Must meet deductible. Then copay applies |
The Mid Plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the BCBS network. The calendar-year deductible must be met before certain services are covered.
Your contributions toward the cost of medical coverage are automatically deducted from your paycheck before taxes.
| Mid Plan - Medical Rates | |
| Coverage | Minimum Employee Cost Share** |
| Employee | $25.00 |
| Employee + Spouse | $281.78 |
| Employee + Child(ren) | $226.34 |
| Family | $461.35 |
*Maximum Employee Cost Share reflects that the employee and/or spouse chose not to complete a health risk assessment (HRA).
**Minimum Employee Cost Share reflects that employee and spouse (if applicable) completed their HRA.
Please note: There may be slight variations in cost between the Maximum and Minimum Cost Share shown here based on HRA completion. For a better understanding of that calculation, please reach out to your City HR team.
BCBS Mid Plan Summary of Benefits and Coverage (SBC) (PDF)
| Medical Benefits | Mid Plan |
|---|---|
| Deductible In-Network Non-Network | $1,250 Ind. / $2,500 Fam. $5,000 Ind. / $10,000 Fam. |
| Out-of-Pocket Maximum In-Network Non-Network | $4,500 Ind. / $9,000 Fam. $15,000 Ind. / $30,000 Fam. |
| Coinsurance In-Network Non-Network | 20% 50% |
| Lifetime Maximum | Unlimited |
| Preventive Care In-Network Non-Network | $0 (no cost sharing) You pay 40% after deductible |
| Telehealth / Virtual Visit | $5 copay |
| Physician Office Visit In-Network Non-Network | $20 copay ($10 for children up to age 19) You pay 50% after deductible |
| Specialist Office Visit In-Network Non-Network | $35 copay ($10 for children up to age 19) You pay 50% after deductible |
| Basic Lab & Radiology In-Network Non-Network | You pay 20%* You pay 50% after deductible |
| Emergency Room In-Network Non-Network | $150 copay, then deductible/coinsurance You pay 50% after deductible |
| Urgent Care In-Network Non-Network | $50 copay You pay 50% after deductible |
| Major Lab & Radiology (MRI / CT / PET) In-Network Non-Network | Prior authorization required You pay 20% after deductible You pay 50% after deductible |
| Inpatient Hospital In-Network Non-Network | You pay 20% after deductible You pay 50% after deductible |
| Outpatient Surgery In-Network Non-Network | You pay 20% after deductible You pay 50% after deductible |
| Prescriptions Network Retail Pharmacy Network Mail Order / 90-Day Retail Now Preventive Generics | $4/$35/$60/15% $8/$70/$120/15% $0 copay |
Like the Mid Plan, the Buy-Up Plan is a preferred provider organization (PPO) plan, which means you have access to a network of health care providers who have contracted with BCBS to provide you services at reduced costs. You will typically pay less when you visit a health care provider who is part of BCBS’s network.
Of the three plans, the Buy-Up Plan has the lowest deductibles and out-of-pocket maximums. This means your out-of-pocket costs under the Buy-Up Plan are theoretically lower than under the HDHP or Mid Plan. On the other hand, you will pay higher premiums.
Your contributions toward the cost of medical coverage are automatically deducted from your paycheck before taxes.
| Buy-Up Plan - Medical Rates | |
| Coverage | Minimum Employee Cost Share** |
| Employee | $111.20 |
| Employee + Spouse | $514.80 |
| Employee + Child(ren) | $427.52 |
| Family | $794.48 |
*Maximum Employee Cost Share reflects that the employee and/or spouse chose not to complete a health risk assessment (HRA).
**Minimum Employee Cost Share reflects that employee and spouse (if applicable) completed their HRA.
Please note: There may be slight variations in cost between the Maximum and Minimum Cost Share shown here based on HRA completion. For a better understanding of that calculation, please reach out to your City HR team.
BCBS Buy-Up Plan Summary of Benefits and Coverage (SBC) (PDF)
| BCBS Buy-Up PPO Key Medical Benefits | In-Network | Out-of-Network |
|---|---|---|
| Deductible (per calendar year) | ||
| Individual / Family | $750 / $1,500 | $2,000 / $4,000 |
| Out-of-Pocket Maximum (per calendar year) | ||
| Individual / Family | $3,000 / $6,000 | $10,000 / $20,000 |
| Company Contribution to Your Health Savings Account (HSA) (per calendar year) | ||
| Individual / Family | N / A | N / A |
| Covered Services | ||
| Office Visits (physician / specialist) | $20 copay / $25 copay | 50% |
| Routine Preventive Care | No charge | 50% |
| Outpatient Diagnostic (lab / X-ray) | 20% | 50% |
| Complex Imaging | 20% | 50% |
| Chiropractic | 20% | 50% |
| Ambulance | 20% | 50% |
| Emergency Room | $150 copay, then deductible/coinsurance | 50% |
| Urgent Care Facility | $50 copay | 50% |
| Inpatient Hospital Stay | 20% | 50% |
| Outpatient Surgery | 20% | 50% |
| Prescription Drugs (Tier 1a / Tier 1b / Tier 2 / Tier 3 / Tier 4 | ||
| Retail Pharmacy (30-day supply) | $4 / $25 / $50 / 15% | 50% |
| Mail Order (90-day supply) | $8 / $50 / $100 / 15% | 50% |