Health Plan Comparison

New PPO Plan

BU Health Savings Plan

BCBS National PPO Network

Out-of-Network Providers

In-Network

Out-of-Network

BMC Providers

All Other Network Providers

Applied Behavior Analysis

Applied Behavior Analysis

$15 copayment per visit (deductible does not apply) $30 copayment per visit (deductible does not apply) 30% coinsurance after deductible Not Covered Not Covered

Chiropractic Care

Chiropractic Care

$15 copayment per visit (deductible does not apply);
20 visits per calendar year
$30 copayment per visit (deductible does not apply);
20 visits per calendar year
30% coinsurance after deductible;
20 visits per calendar year
10% coinsurance after deductible;
20 visits per calendar year
30% coinsurance after deductible;
20 visits per calendar year

Drug and Alcohol Treatment

Drug and Alcohol Treatment

Inpatient No charge after deductible Inpatient Low Cost Provider: No Charge after deductible
High Cost Provider: 20% after deductible
Inpatient 30% coinsurance after deductible Inpatient 10% coinsurance after deductible Inpatient 30% coinsurance after deductible
Outpatient No charge after deductible Outpatient Low Cost Provider: No Charge after deductible
High Cost Provider: 20% after deductible
Outpatient 30% coinsurance after deductible Outpatient 10% coinsurance after deductible Outpatient 30% coinsurance after deductible
Office Visits $15 copayment per visit (deductible does not apply) Office Visits $30 copayment per visit (deductible does not apply) Office Visits 30% coinsurance after deductible Office Visits 10% coinsurance after deductible Office Visits 30% coinsurance after deductible

Durable Medical Equipment

Durable Medical Equipment

10% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible

Emergency Room

Emergency Room

$100 copayment per visit(deductible does not apply); copayment waived if held for observation or admitted within 24 hours 10% coinsurance after deductible 10% coinsurance after deductible

Family Planning

Family Planning

$15 copayment per visit (deductible does not apply) $30 copayment per visit (deductible does not apply) 30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible

Hospital Benefits

Hospital Benefits

General Hospital No charge after deductible General Hospital Low Cost Provider: 10% after deductible;
High Cost Provider: 20% after deductible
General Hospital 30% coinsurance after deductible General Hospital 10% coinsurance after deductible General Hospital 30% coinsurance after deductible
Skilled Nursing Facility 10% after deductible;
100-day benefit limit per member per calendar year
Skilled Nursing Facility 10% after deductible;
100-day benefit limit per member per calendar year
Skilled Nursing Facility 30% after deductible;
100-day benefit limit per member per calendar year
Skilled Nursing Facility 10% after deductible;
100-day benefit limit per member per calendar year
Skilled Nursing Facility 30% after deductible;
100-day benefit limit per member per calendar year

Mental Health Benefits

Mental Health Benefits

Inpatient No Charge after deductible Inpatient Low Cost Provider: No Charge after deductible
High Cost Provider: 20% after deductible
Inpatient 30% after deductible Inpatient 10% after deductible Inpatient 30% after deductible
Outpatient No Charge after deductible Outpatient Low Cost Provider: No Charge after deductible
High Cost Provider: 20% after deductible
Outpatient 30% after deductible Outpatient 10% after deductible Outpatient 30% after deductible
Office Visits $15 copayment per visit (deductible does not apply) Office Visits $30 copayment per visit (deductible does not apply) Office Visits 30% coinsurance after deductible Office Visits 10% coinsurance after deductible Office Visits 30% coinsurance after deductible

MRIs, CT scans, Nuclear Cardiac Imaging & Lab Tests

MRIs, CT scans, Nuclear Cardiac Imaging & Lab Tests

No Charge after deductible Low Cost Provider: 10% after deductible;
High Cost Provider: 20% after deductible
30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible

Physical Therapy

Physical Therapy

$15 copayment per visit (deductible does not apply); copayment waived for physical therapy furnished by BU Physical Therapy Center;
up to 60 visits per calendar year
$30 copayment per visit (deductible does not apply);
copayment waived for physical therapy furnished by BU Physical Therapy Center;
up to 60 visits per calendar year
30% after deductible;
up to 60 visits per calendar year
10% after deductible;
up to 60 visits per calendar year
30% after deductible;
up to 60 visits per calendar year

Physicians’ Services

Physicians’ Services

$15 copayment per visit (deductible does not apply) $30 copayment per visit(deductible does not apply) 30% after deductible 10% after deductible 30% after deductible

Preventive Care

Preventive Care

You pay nothing You pay nothing

Preventive Eye Exams

Preventive Eye Exams

You pay nothing You pay nothing

Deductible Per Calendar Year (single/family)

Deductible Per Calendar Year (single/family)

$250 per member /$500 per family $500 per member $1,000 per family $1,500 employee only $3,000 per family $3,000 employee only $6,000 per family

Out-of-Pocket Maximum

Out-of-Pocket Maximum

$2,500 per member /$5,000 per family $5,000 per member /$10,000 per family $3,000 employee only $6,000 per family $6,000 employee only $12,000 per family

Lifetime Maximum

Lifetime Maximum

None None

Provider Choice

Provider Choice

You must use a BMC network participating provider. You must use a BCBS National PPO network participating provider. You may use the provider of your choice. You must use a BCBS National PPO network participating provider. You may use the provider of your choice.

Copayment

Copayment

$15 per visit for most covered services $30 per visit for most covered services Depending on the service, generally 30% coinsurance after deductible Depending on the service, generally 10% coinsurance after deductible Depending on the service, generally 30% coinsurance after deductible

Benefit Level

Benefit Level

You pay nothing for inpatient services after deductible is met; $30 copayment per visit for some services You pay 10% for inpatient services at a low cost provider and 20% at a high cost provider after deductible is met; $30 copayment per visit for some services 30% coinsurance for most covered inpatient and outpatient services after deductible is met 10% coinsurance for most covered inpatient and outpatient services after deductible is met 30% coinsurance for most covered inpatient and outpatient services after deductible is met

Claim Forms

Claim Forms

Not Required Required Not Required Required

Prescription Drugs

Prescription Drugs

Retail Pharmacy for up to 30 day supply:
Generic Medications
$8 copayment

Preferred Brand Name
20% coinsurance(minimum cost $40; maximum cost $60/prescription)

Non-preferred Brand Name
30% coinsurance(minimum cost $60; maximum cost $80/prescription)

Home Delivery for up to 90 day supply:
Generic Medications
$16 copayment

Preferred Brand Name
20% coinsurance(minimum cost $80; maximum cost $120/prescription)

Non-preferred Brand Name
30% coinsurance(minimum cost $120; maximum cost $160/prescription)
Not Covered 10% after deductible Not Covered