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BLUE CROSS BLUE SHIELD COPAY EMERGENCY ROOM PLUS
BLUE CROSS BLUE SHIELD COPAY EMERGENCY ROOM PROFESSIONAL

The formulary and/or pharmacy network may change at any time. Enrollment in MPDP depends on contract renewal. The FEP Medicare Prescription Drug Program is a prescription drug plan with a Medicare contract.

3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards.

2 If you have Medicare Part B primary, your costs for prescription drugs may be lower.

1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.

^ What you’ll pay for a 30-day supply of covered drugs.

Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.Ĭost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Tier 4 (Preferred specialty): $85 copay 2 Visit the Medicare page for more information. Tier 5 (Non-preferred specialty): $110 copay 2Īvailable to members with Medicare Part B primary only.

Tier 4 (Preferred specialty): $85 copay 2 Tier 3 (Non-preferred brand): 60% of our allowance ( $90 minimum) 2 $0 for first 2 visits and all nutrition visits 1, 2022 – Dec.Nothing for covered preventive screenings, immunizations and services The MOOP amount may change from calendar year to calendar year.**įor calendar years beginning Jan. Premiums and/or premium contributions also do not count toward MOOP. Amounts incurred for non-covered services and other non-covered expenses, such as amounts in excess of plan allowances as well as any financial penalties, do not count toward MOOP. Cost-sharing amounts attributable to services received from Non-Participating Providers generally do not count toward MOOP. MOOP includes deductibles, coinsurance, and copay charge amounts that you must pay for covered in-network services and any applicable riders in a calendar year. MOOP refers to the maximum amount of in-network cost-sharing expenses that you will pay in each calendar year for covered services received from Participating Providers under the GHI/Empire BlueCross BlueShield plans combined.

BLUE CROSS BLUE SHIELD COPAY EMERGENCY ROOM PLUS

You will still pay any applicable out-of-network cost-sharing plus the difference between the provider’s fee and GHI’s reimbursement (which may be substantial).īenefits are subject to approval by the New York State Department of Financial Services. There will be no changes to your current out-of-pocket costs. **$100 for all other New York State facilities $50 for out-of-state facilities

MRI/CAT/High-Tech Radiology: $50 copay for participating RadNet facilities, Zwanger-Pesiri Radiology, Memorial Sloan Kettering, NewYork-Presbyterian Health System, and Hospital for Special Surgery**.

All other specialty providers: $30 copay.

$0 copay if you use an AdvantageCare Physicians (ACPNY) provider.

Coverage for in-network and out-of-network services.

This chart shows the estimated cost of seeing a doctor outside of our network.

BLUE CROSS BLUE SHIELD COPAY EMERGENCY ROOM PROFESSIONAL

Using a health care professional in our network is a cost-effective way to use this plan. The calculator provides estimates for out-of-pocket costs, or what you may pay for certain items and services. If you choose to get services outside of our network, you can use our self-service treatment cost calculator available in the myEmblemHealth member portal. If you do not get a required prior approval, you may not get reimbursed. Hospitalization benefits are provided to you by Empire BlueCross BlueShield. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Most of the reimbursement rates have not increased since that time, and will likely be less (and in many instances substantially less) than the fee charged by the out-of-network provider.

The reimbursement rates in the Schedule are not related to usual and customary rates or to what the provider may charge but are set at a fixed amount based on GHI’s 1983 reimbursement rates. When you choose to use out-of-network doctors, payment for covered services will be made under the NYC Non-Participating Provider Schedule of Allowable Charges. Using an Out-of-Network Health Care Professional In most cases, when you see a network doctor, your cost will just be a copay. You can see any network doctor without a referral. The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors.