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Network Blue New England Options v.3 with Deductible

Network Blue New England Options v.3 with Deductible. Town of Framingham. BENEFIT HIGHLIGHTS. Open Enrollment - Effective date: March 1, 2012 Network Blue and Network Blue Enhanced Value will automatically convert to Network Blue NE Options v3 with Deductible

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Network Blue New England Options v.3 with Deductible

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  1. Network Blue New England Options v.3 with Deductible • Townof Framingham

  2. BENEFIT HIGHLIGHTS • Open Enrollment - Effective date: March 1, 2012 • Network Blue and Network Blue Enhanced Value will automatically convert to Network Blue NE Options v3 with Deductible • No disruption with your current providers • Hospital services are on a tiered platform • New identification cards will be issued

  3. PROVIDER TIERS (MA Hospitals) • Enhanced Tier - Metro West, Newton Wellesley, St. Vincents • Standard Tier - Milford Regional, Beverly, Clinton • Basic Tier - UMASS, MGH, Children’s • Hospitals in other New England States (RI, CT, NH, ME, VT) are all at the Enhanced level of benefits. • See Massachusetts hospital list for which tier your hospital is in.

  4. YOUR COST • Tiered ServiceEnhancedStandardBasic • Plan Year Deductible NONE $250/$750 $250/$750 • Inpatient Admissions $300 $300** $700** • Surgi Day Care $300 $300 ** $700** • High Tech Imaging $100 $100** $100** • Diagnostic X-ray Nothing Nothing ** Nothing** • Lab & Other Test Nothing Nothing ** Nothing** ** AFTER DEDUCTIBLE

  5. YOUR COST (CONT) • Other ServicesYour Cost • Preventive Physical Exams $0 • PCP visits $20 • Behavioral Health Visits $15 • Specialist Office Visits $35 • Emergency Room visits $100 * • RX retail $10/$25/$50 (30 day supply) • Mail Order Rx $20/$50/$110 (90 day supply) • * ER copay waived if admitted. If inpatient admission results from the ER visit at any hospital, then the Enhanced Benefit level applies.

  6. YOUR COST (CONT) • Out-of-Pocket Maximum (per plan year) • $2,500.00 per member • $5,000.00 per family • This includes your paid deductible, coinsurance and any copayments of more than $100, excluding prescription drugs. • Questions? Call Member Services at 800 932-8323

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