Tax Advantage Accounts
Life Events FAQs
Defined Benefit Plans
Residents of Wisconsin
The Premium PPO plan offers flexibility to see any health care provider you choose. However, when you go to an in-network BlueCross BlueShield provider, you are going to receive services at a negotiated discounted fee.
Deductible(At least two individual deductibles must be met to satisfy family deductible)
Family: $900 Maximum
Annual Out-of-Pocket Maximum (Includes deductible)
Coinsurance Paid After Deductible (Applies to all professional services except those noted below.)
You Pay 20%
You Pay 40%
Office Visit Copays (Copays do not apply to deductible or out-of-pocket maximum)
You Pay 35%
Subject to Deductible and Coinsurance
Lab work/Professional Services
Emergency Room Visit Copayment
100% of In-Network Eligible Charges
Periodic Preventive Services
100% of Eligible Charges – not subject to deductible or maximum
Pre-Existing Condition Exclusion
The deductible is the amount you must pay for covered medical services each year before the medical plan begins to pay benefits. The deductibles under the PPO Plans start over each Jan. 1.
If you elect coverage for yourself, the individual deductible applies to you. You must pay for covered medical services for yourself until the deductible has been satisfied.
The plan will not begin to pay for benefits until you meet the individual deductible.
Maximum Lifetime Benefit (unless noted)
Substance Abuse Treatment
$1,500 every three years per covered personSubject to Deductible and Coinsurance
Temporomandibular Joint Dysfunction & related disorders
Physical, Occupational and Speech Therapy
Coverage through Caremark network pharmacy or mail order only
Mail Order(90-day supply)
Preferred Brand Copay
Non-Preferred Brand Copay