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Medical Benefits

Medical benefits are provided through Blue Cross Blue Shield.

Choose the plan that works best for your lifestyle.

 

Consider the physician networks, premiums

and out-of-pocket costs for each plan.

 

Keep in mind your choice is effective for the entire 2023 – 2024 Plan Year,

unless you have a qualifying life event.

Medical Plan Summary

This chart summarizes the 2023 - 2024 Medical coverage provided by Blue Cross Blue Shield (Anthem). All covered services are subject to medical necessity as determined by the plan. Please note that all out-of-network services are subject to Reasonable and Customary (R&C) limitations.

Prescription Drug Coverage

Our Prescription Drug Program is coordinated through Blue Cross Blue Shield. This means you will have one (1) ID card for both medical care and prescriptions. You may find information on our benefits coverage and search for network pharmacies at www.bcbstx.com or by calling the Customer Care number on your ID card. Your cost is determined by the tier assigned to the prescription drug product. Products are assigned as Generic, Preferred, Non-Preferred, or Specialty Drugs.

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On-Site Medical Care

For employees and dependents enrolled in a KEG 1 Medical plan, we provide a benefit through On-Site Medical Care (OSMC). OSMC offers on-demand access in person or through video, telephone, text or secure email. You and your family can be treated for general health issues at home. In addition to being your primary point of contact, OSMC is useful for after-hours non-emergency care, when your primary care doctor is unavailable, if you need prescriptions or refills, or if you are traveling.

What Is Covered
  • Same-day/next-day appointments

  • Wellness and prevention

  • Physicals – Annual/DOT/School

  • Well woman exams

  • Chronic care management (ex. hypertension, cholesterol, diabetes)

  • Unlimited sick visits or follow-up visits

  • In-clinic labs and testing: EKG, point-of-care testing (strep, mono, urinalysis, pregnancy, flu, blood sugar)

  • Procedures: wound repair (glue, staple, stitch), abscess drainage and wound care, wart removal, ear irrigation, toenail removal

  • Specialists: Same day/next day access to over 120 specialists via telehealth. If the patient needs to be referred to a specialist, coordination of care and proper follow-up working closely with the specialist (patient has the option to pay cash or utilize current insurance carrier)

  • Radiology: Will be outsourced to local imaging center (patient has the option to pay pre-negotiated low cost cash pricing or utilize current insurance carrier)

  • 24/7 access to doctor through email or by phone

Be a Smart Consumer

A smart healthcare consumer does not just ask the right questions of their doctor, but knows it is also about prevention, self-care and knowing where to find resources. Making good decisions will have a positive impact on your physical and financial health.

Follow these tips to save time & money

  • Choose generic medications and lower cost brand-name drugs whenever possible – Do not be afraid to ask your doctor for a prescription drug option. Ask your doctor if a generic will be okay.

  • Ask your doctor exactly what tests or procedures he wants you to have and why – Ask why the tests or procedures are necessary before you have them and shop around.

  • Use in-network providers – In-network providers have agreed to discount the charges for their services.

  • Use On-Site Medical Care for non-life threatening emergencies – On-Site Medical Care is available 24/7 via phone, text, or e-mail.

  • Select a primary care doctor – If you do not already have a primary care doctor, take the time to select one. Seek recommendations from family and friends, look to your health plan to see which physicians are in-network, and know what you want from a provider. Your primary care doctor can guide your preventive care program.

  • Use your preventive care benefits – One of the most important things you and your covered dependents can do is use your preventive care benefits. This includes annual physical exams, flu shots, vaccinations, etc. If you practice prevention, you may prevent a more serious health issue in the future.

  • Seek reliable sources of information – Use resources like the library, your doctor, your health plan provider, and reliable websites that you can trust to help you gather the facts. Make sure the information you collect is based on sound medical research, not the results of a single study, a personal blog, or facts published by a company that will profit by you using its product.

  • Review your medical bills – Make sure that the bills you receive from the doctor’s office are accurate. Make sure the exams, procedures, and tests billed were the ones you actually had with the provider who treated you. If you discover a billing error, contact the doctor’s, or other provider’s, billing office immediately. You can also contact BlueCross BlueShield Customer Care at 800-521-2227 if you have any questions about your bill.

  • Know your coverage – View your member responsibilities, such as copay and deductible amounts, at www.bcbstx.com. Copies of your Explanation of Benefits (EOBs) can also be accessed online when you register on Blue Access for Members.

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Important
Information

 

The Medical plan year runs from December 1, 2023 – November 30, 2024; however, deductibles for all plans are on a calendar year cycle and will start over on January 1, 2024. The individual deductible amount must be met by each member enrolled under your Medical coverage. If you have several covered dependents, all charges used to apply toward a “per individual” deductible amount will also be applied toward the “per family” deductible amount. When the family deductible amount is reached, no further individual deductibles will have to be met for the remainder of that plan year. No member may contribute more than the individual deductible amount to the “per family” deductible amount. The same typically applies for the out-of-pocket maximum.

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