Blue cross blue shield federal employee basic vs standard

Compare Benefit Options for 2015 See below for a side-by-side comparison of the Service Benefit Plan’s Standard and Basic Options in 2015. which one is better blue cross blue sheild standard or basic 2014 You can also use AskBlue, an interactive comparison tool to help you choose which plan is right for you.

Blue cross blue shield federal employee basic vs standard
Standard Option is designed to provide flexible and convenient healthcare coverage. Basic Option With Basic Option, choose from an extensive network of Preferred providers.

Standard Option Enjoy the freedom of choice with Standard Option Standard Option provides the flexibility to receive care outside the network. Use any provider at any time.

Medical Benefits Standard Option allows you the freedom to receive care from Preferred providers or Non-preferred providers, whichever you choose.

Maternity Benefits Getting early and regular prenatal care is one of the most important things you can do for the health of both you and your baby. From your prenatal care to postpartum, benefits are designed to support you.

Prescription Drug Coverage Fill your prescriptions at your local retail pharmacy or have them delivered through the mail. Standard Option features a convenient Mail Service Pharmacy Program.

Basic Option Convenient and affordable coverage
Enjoy a lower premium and no deductibles with Basic Option. Choose from an extensive network of Preferred providers for all of your medical needs. With a Preferred provider, there are no claims to file—the provider takes care of it for you.

Medical Benefits Under Basic Option, you are required to use Preferred providers. There is no calendar year deductible under Basic Option. Pay just $25 for each office visit to a Preferred primary care provider and a $35 copayment when you see a Preferred specialist.

Blue cross blue shield federal employee basic vs standard

Prescription Drug Coverage As a Blue Cross and Blue Shield Service Benefit Plan member enrolled in Basic Option, you must use a Preferred retail pharmacy.

Maternity Benefits Getting early and regular prenatal care is one of the most important things you can do for the health of both you and your baby. From your prenatal care to postpartum, benefits are designed to support you.

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Decide which Service Benefit Plan Option is right for you by reviewing our comparison tables for Standard Option and Basic Option.

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Know Your Benefit Options Through the Blue Cross and Blue Shield Service Benefit Plan, you can choose to receive coverage under Standard Option or Basic Option. There are a few key differences to consider.

  1. While Basic Option requires that you use Preferred providers to receive benefits, you can go outside of the network with Standard Option.
  2. Standard Option has a calendar year deductible, while Basic Option does not.
  3. You will pay a copayment amount for most of the care you receive under Basic Option. Under Standard Option, your out-of-pocket costs include copayment and coinsurance amounts.

We’ve outlined a summary of these coverage options. These charts show what you will pay when using Preferred providers. You can click here to download and print this chart.

2015 Preventive Care Preventive care is important at any age. It helps to identify any health concerns or conditions in the early stages of development, making them easier to treat. Any related complications may also be easier to treat.

Hospital / Facility Care Comparison
Benefits Standard Option*  
You Pay:
Basic Option** –
You Pay:
Hospital inpatient
Pre-certification is required
$250 per admission copayment for unlimited days $175 per day up to $875 per admission for unlimited days
Outpatient hospital /
facility care
15% of the Plan allowance $100 per day facility copayment
Prescription Drugs Comparison
Benefits Standard Option* 
You Pay:
Basic Option** –
You Pay:
Mail Service Pharmacy Program Tier 1 (generics)‡: $15 copayment

Tier 2 (preferred brand name): $80 copayment

Tier 3: (non-preferred brand name): $105 copayment

Covers 22-90 day supply
Nothing for the first 4 prescription fills or refills when
you switch from certain brand name drugs to specific generic drugs

N/A
Retail Pharmacy Program Tier 1(generics): 20% coinsurance 

Tier 2 (preferred brand name): 30% coinsurance

Tier 3 (non-preferred brand name): 45% coinsurance

Covers up to a 90-day supply
Nothing for the first 4 prescription fills or refills when
you switch from certain brand name drugs to specific generic drugs when
your use a Preferred pharmacy

Tier 4 (preferred specialty drugs): 30% coinsurance

Tier 5 (non-preferred specialty drugs): 30% coinsurance

Tier 4 and 5 specialty drugs are limited to a 30-day supply;
only one fill allowed. All refills must be obtained from the Specialty
Pharmacy Program.

Tier 1 (generics): $10 copayment

Tier 2 (preferred brand name): $45 copayment

Tier 3 (non-preferred brand name): 50% coinsurance with a $55 minimum

Covers 30-day supply, up to 90 day supply for additional copayments

Tier 4 (preferred specialty drugs): $60 copayment (30-day supply)

Tier 5 (non-preferred specialty drugs): $80 copayment (30-day supply)

Tier 4 and 5 specialty drugs are limited to a 30-day supply;
only one fill allowed. All refills must be obtained from the Specialty
Pharmacy Program.

Specialty Pharmacy Program Tier 4 (preferred specialty drugs): $35 copayment (30-day supply); $95 copayment (90-day supply)

Tier 5 (non-preferred specialty drugs): $55 copayment (30-day supply); $155 copayment (90-day supply)

90-day supply can only be obtained after 3rd fill

Tier 4 (preferred specialty drugs): $50 copayment (30-day supply); $140 copayment (90-day supply)

Tier 5 (non-preferred specialty drugs): $70 copayment (30-day supply); $195 copayment (90-day supply)

90-day supply can only be obtained after 3rd fill

Lab, X-ray and Other Diagnostic
Services Comparison

Benefits Standard Option* 
You Pay:
Basic Option** –
You Pay:
Diagnostic test
(X-ray, blood work)

Imaging
(CT/PET scans, MRIs)

15% of the Plan allowance $0 copayment for laboratory tests, pathology services and EKGs

$40 copayment for diagnostic tests such as EEGs, ultrasounds and X-rays

$100 copayment for bone density tests, sleep studies, CT
scans, MRIs, PET scans, angiography, genetic testing and nuclear
medicine at a professional provider; $150 copayment at hospital

Emergency Care Comparison
Benefits Standard Option* 
You Pay:
Basic Option** –
You Pay:
Accidental injury Nothing for outpatient, hospital and physician services within 72 hours $125 copayment for emergency room care

$50 copayment for urgent care center

Regular benefits for physician care

Medical emergency Regular benefits for physician and hospital care; $30 copayment for urgent care center $125 copayment for emergency room care

$35 copayment for urgent care center

Regular benefits for physician care

Maternity Care Comparison
Benefits Standard Option* 
You Pay:
Basic Option** –
You Pay:
Obstetrical care performed by a physician or nurse midwife, such as prenatal care (including ultrasound, lab, and diagnostic tests), delivery, postpartum care Nothing for covered services Nothing for covered services
Inpatient hospital
Precertification is not required for normal delivery
Note: You may stay in the hospital for up to 48 hours after a regular delivery and 96 hours after a C-section. We will cover a longer stay if medically necessary; precertification is required for any inpatient stay beyond these time frames.
Nothing for covered services $175 copayment per admission
Outpatient facility care, including outpatient care at birthing facilities Nothing for covered services Nothing for covered services
Breastfeeding Comparison
Benefits Standard Option*
You Pay:
Basic Option**
You Pay:
Breastfeeding education and individual coaching on breastfeeding by a physician, physician assistant, nurse midwife, nurse practitioner/clinical specialist, or registered nurse certified lactation consultant Nothing for covered services Nothing for covered services
Breast pump kits, limited to one of the two kits listed below, per calendar year for women who are pregnant and/or nursing:
• Ameda Manual pump kit
• Ameda Double Electric pump kit

Benefits for the breast pump kit and milk storage bags are only available when you order them through CVS Caremark by calling 1-800-262-7890.

Nothing for covered services Nothing for covered services
Maternity Mental Health Comparison
Benefits Standard Option*
You Pay:
Basic Option**
You Pay:
Mental health treatment for postpartum depression and depression during pregnancy, when services are performed by a Preferred provider Nothing up to 4 visits per year

See Section 5(e) in the Service Benefit Plan brochure for benefits for additional mental health services

Nothing up to 4 visits per year

See Section 5(e) in the Service Benefit Plan brochure for benefits for additional mental health services

Dental Care Comparison
Benefits Standard Option*  
You Pay:
Basic Option** –
You Pay:
Routine dental care Your out-of-pocket expenses are limited to
the balance after our payment up to the Maximum Allowable Charge
$25 copayment per evaluation up to 2 per calendar year 
Preventive care only
Chiropractic / Osteopathic
Manipulative Treatment Comparison
Benefits Standard Option*  
You Pay:
Basic Option** –
You Pay:
Manipulative treatment $20 per visit copayment up to 12 manipulations per year $25 per visit copayment up to 20 manipulations per year
Mental Health and Substance Abuse Comparison
Benefits Standard Option*  
You Pay:
Basic Option** –
You Pay:
Inpatient Hospital/Facility 
Pre-certification is required
$250 per admission copayment for unlimited days $175 copayment per day up to $875 per admission for unlimited days
Outpatient Hospital /
Facility Care
Subject to the calendar year deductible (Individual or Family)

15% of Plan allowance 

$25 copayment per day per facility
Inpatient Professional Care Nothing for covered professional visits Nothing for covered professional visits
Outpatient Professional Care $20 per visit copayment  $25 per visit copayment
Educational Classes and Programs
Benefits Standard Option* –
You Pay:
Basic Option** – You Pay:
  • Smoking and tobacco cessation treatment
  • Individual counseling for smoking and tobacco use cessation. Note: Benefits are not available for group counseling.
  • Smoking and tobacco cessation classes
Nothing for covered services Nothing for covered services
Smoking and Tobacco Cessation Drugs
Benefits Standard Option* – 
You Pay:
Basic Option** – You Pay:
Preferred Retail Pharmacy Tier 1 (generics)?: 20% coinsurance

Tier 2 (Preferred brand name)
30% coinsurance

Tier 3 (Non-preferred brand name)
45% coinsurance; Covers up to a 90-day supply

Tier 1 (generics): $10 copayment

Tier 2 (Preferred brand name)
$45 copayment

Tier 3 (Non-preferred brand name)
50% coinsurance 
with a $55 minimum; Covers 30-day supply, up to a 90-day supply for additional 
copayments

Mail Service Pharmacy

Tier 1 (generics)?
$15 copayment

Tier 2 (Preferred brand name)
$80 copayment

Tier 3 (Non-preferred brand name)
$105 copayment;
Covers 22-90 supply

 Not a benefit
Other Benefits Comparison
Benefits Standard Option*  
You Pay:
Basic Option** –
You Pay:
Catastrophic Benefits 100% payment level begins after you pay $5,000 (Self Only) or $6,000
(Self and Family) out-of-pocket in eligible coinsurance, copayment, and
deductible expenses with Preferred providers
100% payment level begins after you pay $5,500 (Self Only) or $7,000
(Self and Family) out-of-pocket in eligible coinsurance and copayment
expenses

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