A copayment is the cost you're required to pay for certain services or prescription drugs.
Doctor's office visit: $20 per visit
Specialist visit: $20 per visit
Emergency room: $75 per visit (waived if admitted or for observation stay)
Prescription drugs: $10 for generic and $20 for brand-name at designated retail pharmacies (up to a 30-day formulary supply for each prescription or refill)1
1. Cost share waived for birth control.
The out-of-pocket maximum is the most you pay per plan year for covered health expenses before the plan pays 100 percent of covered expenses for the rest of the year. Log in to MyBlue to see how much you've spent toward your out-of-pocket maximum.
Your out-of-pocket maximum is $2,500 for individual coverage or $5,000 for family coverage.
Your out-of-pocket maximum for prescription drug benefits is $1,000 per member (or $2,000 per family).
Active Employees
