See Prescription Drug Plans for information on the prescription drug coverage and coinsurance/copayments. Two married active state employees who cover children may combine medical deductibles by participating in a Family Roll Up. If one or more additional family members meet the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the entire family. If two or more family members are covered in a PPO plan and one family member reaches the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the individual. Active employees with a health care Flexible Spending Account (FSA) may receive reimbursement for qualified medical expenses by submitting a claim and providing necessary documentation to MoCAFE (see HSA vs FSA).At that time, the plan will begin paying 100 percent of covered services (see Family Coverage section below). However, members will now pay coinsurance on covered expenses until their out-of-pocket maximum is reached. Once the deductible is met, members will continue to pay copayments.Chiropractor copayment may be $20 or 50% of the total cost of the service, whichever is less.Any lab, X-ray or other services associated with the visit will apply to the deductible and coinsurance. The office visit copayments cover the visit only.The member will also pay for other medical expenses out of their pocket until the annual deductible is met (see Copayments section above). When visiting a health care provider, the member will pay a copayment for each visit.Members also have a $200 copayment for inpatient services in addition to coinsurance.Ĭopayments apply to the out-of-pocket maximum, but not the deductible. The Emergency Room copayment is waived if the member is admitted to the hospital or the services are considered by the medical plan to be a “true emergency.” Even if the copayment is waived, the member will still have to pay any deductible or coinsurance owed for the Emergency Room service. Members may pay a $250 copayment for Emergency Room services in addition to deductible and coinsurance. “World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.Members will pay a copayment for office visits and urgent care. BLUE CROSS ®, BLUE SHIELD ® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. are independent licensees of the Blue Cross and Blue Shield Association. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. of Maryland (used in VA by: First Care, Inc.). Find out if a prescription drug is covered by your plan. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. Choose from quality doctors and hospitals that are part of your plan with our Find Care tool. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and Group Hospitalization and Medical Services, Inc. Serving Maryland, the District of Columbia, and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. No copay - Covered Unlimited access to urgent care at these locations: UMC Quick Care and Primary CareNow Urgent Care (16 locations) Good Night Pediatrics Nevada 2651 N.
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