Active Members

Quick Reference

Locate the provider finder, and learn more details about your medical coverage at capbluecross.com.

Learn about your prescription coverage at savrx.com.

Visit blue365deals.com to learn about great discounts on gym memberships, activity trackers, exercise equipment, and more.

Highlights

Here are some key facts about your medical coverage. It’s important to understand that the plan works differently depending on whether the provider you use is within our network.

If your provider is in-network:
Deductible
(per benefit period)
$200 per member
$400 per family
Coinsurance
(amount you pay after your deductible is met)
No member coinsurance
Out-of-pocket limit
(includes coinsurance; once met, plan pays 100% coinsurance for the rest of the benefit period)
Not applicable
Total out-of-pocket maximum
(includes deductible, coinsurance, copays, and other qualified medical expenses. Network only. After this is met, the plan pays 100% of covered services for the rest of the benefit period.)
$7,900 per individual
$15,800 per family
Office visits $20 per visit
$35 per specialist visit
Urgent care visits $35 per visit
Emergency room $100 copay per visit, waived if admitted
Virtual visits $10 copay
$35 for specialist
Fee is waived due to COVID-19 until June 15, 2020
If your provider is out-of-network:
Deductible
(per benefit period)
$400 per member
$800 per family
Coinsurance
(amount you pay after your deductible is met)
20% coinsurance
Out-of-pocket limit
(includes coinsurance; once met, plan pays 100% coinsurance for the rest of the benefit period)
$4,000 per individual
$8,000 per family
Total out-of-pocket maximum 
(includes deductible, coinsurance, copays, and other qualified medical expenses. Network only. After this is met, the plan pays 100% of covered services for the rest of the benefit period.)
Not applicable
Office visits 20% coinsurance after deductible
Urgent care visits 20% coinsurance after deductible
Emergency room $100 copay per visit, waived if admitted

For more details, review your medical plan details below.

Details

See all your medical plan details
Review the preventive services included in your coverage
Learn more about preauthorization, partial listing – contact Capital for a complete listing
Find out about Fitness Your Way, including $29-per-month gym memberships!
Learn about the Sav-Rx program