Health Plan Comparison Chart

Plan Benefit Network Blue New England BU Health Savings Plan BCBS PPO Plan
BMC PCP and referrals Non-BMC PCP
and referrals
In-
network
Out-of-Network In-
network
Out-of-network
Annual Deductible (calendar year) None None $1,500 employee only;
$3,000 any family plan*
$3,000 employee only;
$6,000 any family plan*
None $500 employee only;
$1,000  family plan
Annual Out-of-Pocket Limit $6,350 employee only;
$12,700 family plan
$6,350 employee only;
$12,700 family plan
$3,000 employee only;
$6,000 any family plan*
$6,000 employee only;
$12,000 any family plan*
$2,500 employee only;
$5,000 family planNone
$2,500 employee only;
$5,000 family plan
Lifetime Maximum Benefit None None None None None None
Inpatient Hospital You pay nothing $200 copay per admission You pay 10% after deductible You pay 30% after deductible You pay nothing You pay 20% after deductible
Hospital Services for mental health and substance abuse You pay nothing You pay nothing You pay 10% after deductible You pay 30% after deductible You pay nothing You pay 20% after deductible
Doctors’ Office Visits with PCP You pay a $15 copay You pay a $30 copay You pay 10% after deductible You pay 30% after deductible You pay a $20 copay You pay 20% after deductible
Doctors’ Office Visits with Specialist You pay a $15 copay You pay a $40 copay You pay 10% after deductible You pay 30% after deductible You pay a $20 copay You pay 20% after deductible
Doctors’ Office Visits for mental health and substance abuse You pay a $15 copay You pay a $40 copay You pay 10% after deductible You pay 30% after deductible You pay a $20 copay You pay 20% after deductible
Emergency Room (waived if admitted) You pay a $100 copay;
waived if admitted
You pay a $100 copay;
waived if admitted
You pay 10% after deductible You pay 30% after deductible You pay a $100 copay;
waived if admitted
You pay a $100 copay;
waived if admitted
Outpatient Surgery: Office You pay a $15 copay You pay a $40 copay You pay 10% after deductible You pay 30% after deductible You pay a $20 copay You pay 20% after deductible
Outpatient Surgery: Surgical facility, hospital You pay a $25 copay You pay a $100 copay per admission You pay 10% after deductible You pay 30% after deductible You pay nothing You pay 20% after deductible
Preventive Care (routine physical,well-child care, GYN exam, lab, X-ray, mammogram) You pay nothing You pay nothing You pay nothing You pay 30% after deductible You pay nothing You pay 20% after deductible
Annual Vision Exam You pay nothing You pay nothing You pay nothing You pay 30% after deductible You pay nothing You pay 20% after deductible
Short-term Rehabilitation Therapy (physical and occupational) You pay a $15 copay
per visit up to benefit limit; then you pay all costs
You pay a $40 copay
per visit up to benefit limit; then you pay all costs
You pay 10% after deductible You pay 30% after deductible You pay a $20 copay per visit, up to 60 visits per calendar year*, then you pay all costs You pay 20% after deductible,up to 60 visits per calendar year*
Diagnostic Lab and X-ray (including MRIs, PET & CT Scans) You pay a $25 copay You pay a $50 copay You pay 10% after deductible You pay 30% after deductible You pay a $20 copay You pay 20% after deductible
Durable Medical Equipment 20% coinsurance 20% coinsurance You pay 10% after deductible You pay 30% after deductible You pay nothing You pay 20% after deductible
Chiropractic Services (20 visit member limit per calendar year) You pay a $15 copay
per visit up to benefit limit; then you pay all costs
You pay a $40 copay
per visit up to benefit limit; then you pay all costs
You pay 10% after deductible up to benefit limit, then, you pay all costs You pay 30% after deductible You pay a $20 copay
per visit up to benefit limit; then you pay all costs
You pay 20% after deductible up to benefit limit, then, you pay all costs
Rehabilitation Hospital (60 days per calendar year) You pay nothing
per visit up to benefit limit; then you pay all costs
You pay nothing
per visit up to benefit limit; then you pay all costs
You pay 10% after deductible up to benefit limit, then, you pay all costs You pay 30% after deductible You pay nothing You pay 20% after deductible
Skilled Nursing Facility (100 days per calendar year) You pay nothing
per visit up to benefit limit; then you pay all costs
You pay nothing
per visit up to benefit limit; then you pay all costs
You pay 10% after deductible up to benefit limit, then, you pay all costs You pay 30% after deductible You pay nothing You pay 20% after deductible
Prescription drug coverage for all plans is provided through Express Scripts.
*For the BU Health Savings Plan the family deductible and out-of-pocket maximum can be met by amounts paid by one family member or any combination of family members enrolled under the same family plan. The entire amount of the family deductible must be met before benefits will be provided for any other member.
Note: This is a summary only. Refer to your certificate of coverage for complete plan details and information on any limitations and exclusions that apply. The certificate will govern provision and payment of plan benefits.