In today’s world of ever-escalating medical costs, it is important for you and your immediate family members to have adequate medical insurance coverage. We feel that the medical benefits offered at TAC are among the best available anywhere.
Overview of Benefits
The following is a brief overview of TAC’s current medical insurance program. The Arkansas Blue Cross Blue Shield Group Benefit Certificate/Insurance Policy will provide specific details.
Provider: Arkansas Blue Cross Blue Shield
Plan Type: PPO (Preferred Provider Organization)
What is a PPO?
A PPO is a health plan with a network of providers (hospitals, physicians, etc.) whose services are available to plan participants at lower costs than those of non-network providers. As a member of a PPO, you are free to select virtually any healthcare provider. However, cost-saving features such as pre-negotiated rates and a higher level of benefits are available only when you use participating providers. When you utilize the services of network providers, you save money—-for yourself and for the plan.
A current list of providers, including their addresses, phone numbers and directions to their facilities, is available on the Arkansas Blue Cross Blue Shield website at www.arkbluecross.com.
How much does it cost?
Medical coverage is available for TAC employees, and their dependents. To help offset the cost of this coverage, TAC pays 50% of the premiums. The other 50% is made automatically through pre-tax payroll deductions. To help ensure we can continue offering quality, affordable health coverage, our PPO also has many other advantages when you stay within the network, including:
- In-network primary care physicians will honor the plan’s $25 co-pay feature.
- In-network specialist physicians will honor the plan’s $50 co-pay feature.
- Claims are filed automatically.
- Co-pay (the amount of charges the participant is responsible for paying) for most medical costs is only 20% of the total covered charges. Out of network, your co-pay is 40%.
- In-network providers will accept the plan’s payment, plus any deductible and co-pay that a participant owes, as payment in full.
Medical Insurance Premiums (Per Pay Period)
|Employee + Children||$152.23|
|Employee + Spouse||$219.13|
Deductibles and Out-of-Pocket Expenses
As with all medical plans, the TAC plan, through Blue Cross Blue Shield of Arkansas, requires that participants pay a portion of their medical bills. In our PPO, there are two methods of determining your out-of-pocket expenses. The first is a deductible (a maximum set amount of expenses that plan participants pay).
When participants visit an in-network Primary Care Physician (a general or family practice physician, an internist or a pediatrician), or specialist, there is no deductible to be met and the co-pay is paid at the time services are rendered.
The TAC plan has a $1,000 per calendar year deductible per person and a $2,000 per calendar year deductible for plans covering more than one individual. Once the deductible is met, the plan begins to make benefit payments.
For those participants who elect family coverage: Once anyone covered by the plan has satisfied one deductible, the remaining participants may combine their expenses to make up the balance of the second deductible.
Once deductibles have been met, the plan will pay 80% of the next $10,000 of in-network covered charges for individuals or $20,000 for plans covering more than one individual. These two limits are the plan’s Stop Loss (the point at which participants stop having to pay a percentage of the covered charges). After reaching the Stop Loss amount, the plan will then pay 100% of all in-network covered charges.
If using out-of-network providers, the plan will pay 60% of covered charges after the deductibles have been met. There is no Stop Loss on out-of-network services.
A covered charge is the amount for a specific service that the plan considers fair and reasonable. All in-network providers have contractually agreed to these amounts for specific services. Out-of-network providers are not bound to these predetermined amounts.
Prescription Drug Benefits
As with other providers, there are specific pharmacies that are a part of the Blue Cross Blue Shield PPO. The plan will only cover prescriptions filled at these in-network pharmacies, so participants should check with their pharmacist to see if their pharmacy is a participant in the plan.
The following rates apply to prescription drugs:
- Generic Drugs: $10.00 per prescription
- Brand Name Drugs (Tier 1): $40.00 per prescription
- Brand Name Drugs (Tier 2): $60.00 per prescription
We encourage participants to ask their physician about the availability of generic alternatives when receiving a prescription. If a generic is available, but the prescription is for only a brand name, participants will not only have to pay the co-pay, but will also have to pay the difference in cost between the brand name and the generic alternative.
Understand Your Plan and Its Benefits
The better our participants understand their health plan and how benefits are paid, the less their out-of-pocket expenses will be. The information contained here is only a brief overview of the plan and its benefits. The complete Arkansas Blue Cross Blue Shield Group Benefit Certificate/Insurance Policy has specific details, or you can always call the Human Resources Department at 903-794-3835 for additional information, or for answers to specific questions.