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WILL AND KENDALL COUNTIES ANDNegotiation Agreement • June 11th, 2019
Current Plan Blue Cross Combined Plan Options Blue Cross Blue Shield Benefits HDHP PPO HMO Coinsurance:Lifetime Maximum - Combined: 100%Unlimited 90%Unlimited 100%Unlimited Calendar Year Deductible Individual:Family:4th Quarter Deductible Carryover Y/N? $2,700$5,200No $500$1,500Yes None None N/A Out-of-Pocket Maximum (In-Network Copays and Coinsurance):Individual: Family: $2,700$5,200 $1,000$3,000 $1,500$3,000 Hospitalization: 100% (After Deductible) 90% (After Deductible) 100% Physician/Specialist Office Visit: Preventive Care: 100% (After Deductible) $20/$40 then 100% 100% (No deductible) $20 then 100% 100% Emergency Room: 100% (After Deductible) $150 then 100% (Copay waived if admitted) $100 then 100% Prescription Drugs:Out-of-Pocket Maximum:Individual: Family:Retail Level 1/L2/L3/L4: Mail-Order (90 day supply): Step Therapy Y/N? None None100% (After Deductible)100% (After Deductible) Yes $500$1,500$10/$25/$35 2 copaysYes $1,000$2,000$10/$20/$35 (self injectabl
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WILL AND KENDALL COUNTIES ANDNegotiation Agreement • June 11th, 2019