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Medical
Plan
 I need
help with........
Eligibility
Full-time and part-time (20+hrs) employees and their legal dependents; coverage begins the first of the month following 30 days of full-time or part-time service.
What is covered
BCBS of NC Group Medical Plan |
In-Network |
Out-of-Network |
Policy Year Deductible |
$2,500 per member
$5,000 per family
|
$5,000 per member
$10,000 per family
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Policy Year Coinsurance Limit
(excludes deductible) |
$3,000 per individual
$6,000 per family
|
$6,000 per individual
$12,000 per family
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Coinsurance level
(% BCBS pays) |
80% |
70% |
Lifetime Maximum |
Unlimited |
Unlimited |
Primary Office Visit |
$25 Co-pay |
Covered at 70% after Deductible |
Specialist Office Visit
(No Referral Required)
|
$50 Co-pay |
Covered at 70% after Deductible |
Wellness & Preventive Care |
Covered at 100%, limits apply |
Limited services covered at 70% after Deductible |
Emergency Room |
$300 Co-pay |
$300 Co-pay, if emergency |
Urgent Care |
$50 Co-pay |
$50 Co-pay, if urgent services |
Inpatient Hospital Services |
Covered at 80% after Deductible |
Covered at 70% after Deductible |
Outpatient Hospital Services |
Covered at 80% after Deductible |
Covered at 70% after Deductible |
Simple Lab & Diagnostic Tests
In a Physician's Office |
No Additional Co-pay |
Covered at 70% after Deductible |
Outpatient Diagnostic Procedures
MRI/MRA, CT, PET Scans
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Covered at 80% after Deductible |
Covered at 70% after Deductible |
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| Retail Pharmacy Benefits |
Retail Co-pay for up to 34 day supply* |
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Tier 1 |
$4 Co-pay |
Co-pay + charge over in-net allowed amount |
Tier 2 |
$40 Co-pay |
Co-pay + charge over in-net allowed amount |
Tier 3 |
$55 Co-pay |
Co-pay + charge over in-net allowed amount |
Tier 4
(Specialty drugs)
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Covered at 75%
(member max out-of-pocket per RX $100) |
Coinsurance + charge over in-net allowed amount |
| *90-day Mail Order RX: 3 times retail cost |
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NOTE:
This is only a summary of the benefits under your BCBS of NC Group Medical Plan. Please refer to your Certificate of Coverage for details on benefits, limitations and exclusions.
The covered benefits for complementary and alternative medicine
Chiropractic care, acupuncture, naturopathy, massage therapy and natural drug
formularies have special pricing if you use certain preferred providers. To
learn more about local providers, click below:
Complementary and Alternative medicine benefits must be obtained through providers
participating in the Alternative
Healthcare Options (AHO) PPO, or an affiliated network provider
identified by AHO.
Preferred providers
For physician and hospital network information you may access the following web site.
(After you connect, click "FIND A DOCTOR" at the top of the page)
When traveling, you may access the www.bcbsa.com and
select “Blue Card” to locate PPO hospitals and physicians thru
out the U.S.
Cost of coverage
You
and Rehab Solutions share in the cost of this coverage. Click on the
link below to view these costs. You will need a User Id, which will
always be rehab, and the monthly password.
You can get the current password from Human
Resources.
Continuing coverage after I stop working at Rehab Solutions, Inc.
You may continue coverage for you and your
legal dependents at your own expense. Certain conditions apply. You will
be provided with the proper forms, information, and costs upon leaving your
employment with Rehab Solutions, Inc
Other resources
- Lindsey Janneck
Human Resources/Payroll Administrator
Rehab Solutions, Inc.
Phone, 1-704-841-9574 ext.22 , 1-800-273-3418
Fax, 1-888-271-3830
ljanneck@rehabsolutionsinc.net
Online forms
You
may obtain the following forms simply by clicking on the description. Since
these files are in a special format (PDF) you will need to download the Adobe
Acrobat Reader
Online booklet
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