Medical, pharmacy, and vision plans Blue Solutions® health plans for small business employers
Our Blue Solutions portfolio helps meet the unique needs of small employers. Choose from a wide variety of medical plans designed to help you lower costs and offer access to high-quality, affordable care. Our health plans cover all required essential health benefits — like in-office and virtual doctor visits, preventive care, hospital stays, emergency services, and prescription drugs — and include dental coverage for children, plus vision coverage for both adults and children.
All medical plans feature enhanced virtual care benefits, like telemedicine, teledermatology, telebehavioral1, and telenutrition health services from MDLIVE® 2 and participating doctors and specialists who offer these services.
View/download our 2023 Blue Solutions overview brochure for complete details.
Personal Choice® PPO plans
PPO plans offer your employees the flexibility to choose in-network (preferred) or out-of-network (non-preferred) providers. However, much higher out-of-pocket costs may apply for out-of-network care. PPO plans do not require PCP selection or referrals to access care. In-network benefits are available coast-to-coast through the BlueCard® PPO network and around the world through Blue Cross Blue Shield Global Core®.
Personal Choice® EPO plans
EPO plans give your employees access to any doctor or hospital in our PPO network, without requiring PCP selection or referrals. Out-of-network providers are not covered except for emergency and urgent care. EPOs combine the flexibility of a PPO and the cost savings of an HMO. In-network benefits are available coast-to-coast through the BlueCard® PPO network and around the world through Blue Cross Blue Shield Global Core®.
Keystone Direct POS plans
Direct POS plans provide both in- and out-of-network coverage, with the flexibility to visit most specialists without a referral. Emergency and urgent care access is also available outside the U.S.3 Members pay less for care in the Keystone Health Plan East network, and more when they go out-of-network.
Members must select a participating PCP to coordinate their care. To pay the lowest cost, members should get a referral or prescription from their PCP and visit designated sites for lab work, radiology, and physical and occupational therapy. The Away From Home Care® program is included for employees who temporarily reside outside the service area.
Keystone HMO plans
HMO plans are designed to help your employees save money. A participating PCP coordinates all of their care and provides referrals for services with in-network specialists. Out-of-network providers are covered only for emergency services. Emergency and urgent care access is also available outside the U.S., as well as our Away From Home Care® program for employees who temporarily reside outside the service area.
Keystone HMO Proactive plans
Our Keystone HMO Proactive health plans are a popular choice for small employers because they give members access to the full Keystone HMO network at a lower premium. Keystone HMO Proactive plans work just like a typical HMO and use a tiered provider network — providers are grouped into three tiers based on cost and quality measures. Members choose a PCP to coordinate their care and refer them to specialists. They pay the lowest out-of-pocket costs by using doctors and hospitals in Tier 1 – Preferred. More than 50 percent of doctors and hospitals in our network are in the lowest-cost tier.
Certain services, including preventive care, urgent care, and prescription drugs, are not tiered and have the same cost-share. Emergency and urgent care access is also available outside the U.S., as well as our Away From Home Care® program for employees who temporarily reside outside of the service area.
High-deductible health plans (HDHPs)
HDHPs offer members the flexibility of a PPO with lower monthly premiums but higher deductibles. Choose from two fully integrated spending account options — either a BlueSaver® Health Savings Account (HSA) through our preferred vendor, or a BlueSaver® Health Reimbursement Account (HRA). Both offer you easy, integrated account maintenance and online reporting, convenient funding methods, and reduced federal, state, and FICA tax liability.
Pharmacy benefits
Every Blue Solutions health plan includes prescription drug coverage, so your employees have safe, affordable access to covered medications. Because medical and pharmacy benefits are integrated, our services are cost-effective and comprehensive. This helps us to better manage overall costs, improve health outcomes, and deliver a better member experience. Plus, you get the capabilities and negotiating power of a top-tier pharmacy benefits manager (PBM).
Our prescription drug benefits4 give your employees access to:
- A large participating network. The network includes more than 68,000 retail and independent pharmacies nationwide.5
- Low-cost generic6 medications are available. Members can find a list of these medications in the Value formulary at ibx.com.
- Online and mobile tools. In addition to a pharmacy lookup tool, members can use the Price a Drug tool at ibx.com as well as the IBX mobile app to get the cost of a specific drug and compare savings by choosing a generic equivalent or switching from retail to mail order.
- Mail order. Mail order/home delivery is available for certain maintenance medications with free shipping. Members may save money by getting 90-day fills of their maintenance medication at Rite Aid for the same cost-share as mail order/home delivery.
- Specialty drug savings. We use several strategies to manage costs and care for members. Our specialty pharmacy program provides convenient delivery options and support for members with complex and high-cost conditions.
- Formulary management. This includes drugs based upon medical effectiveness, safety, and value.
- Integrated data application. This enables better utilization and clinical management — providing an improved and holistic experience for you and your employees.
Vision benefits
Every Blue Solutions health plan includes high-quality, affordable adult and pediatric vision benefits7. Administered by Davis Vision8, our adult and pediatric vision benefits give members access to routine eye care, options for affordable, quality eyewear, and more value-added services. Our vision benefits go beyond access to eye exams and eyewear. Employees have access to:
- National network of more than 116,000 access points
- Low-to-no copay on Davis Vision Exclusive Collection frames or an allowance towards any frame purchase
- Exclusive $50 frame allowance enhancement at Visionworks9
- Safe and convenient online in-network shopping options, including 1800Contacts.com, Glasses.com, Visionworks.com, and Befitting.com
- Fixed copays on all lens styles and coatings, including protection against blue-light exposure
- Discounted pricing and financing options on LASIK laser vision correction services
- Free hearing exam, exclusive discounts on hearing aids and supplies, and more from Your Hearing Network10 through Davis Vision
- An interactive frame try-on tool allows members to see what Davis Vision Exclusive Collection frames look like on before purchasing them
- Upgraded inventory of Davis Vision Exclusive Collection catalogue of designer frames offers even more stylish options to choose from
Dental benefits
All Blue Solutions medical plans cover in-network dental benefits for children up to age 19. Administered by United Concordia Companies, Inc., PPO and DHMO pediatric dental plans include in-network preventive exams and cleanings covered in full to help children develop good oral health.
For extra coverage, you have the option to add standalone dental coverage for your employees’ families or adult dental to your medical benefits.
1 In addition to the Independence Blue Cross behavioral health network, Magellan Behavioral Health, Inc., an independent company, provides limited network and management services for mental health and substance abuse benefits.
2 MDLIVE is an independent company providing virtual care services for Independence Blue Cross.
3 Referrals are required for physical/occupational therapy, spinal manipulation, acupuncture, and radiology. For lab work, a member’s primary care physician will provide a requisition form.
4 Our prescription drug plans are administered by an independent pharmacy benefits management (PBM) company.
5 The Preferred Pharmacy network, which includes more than 58,000 retail pharmacies, is included in Silver and Bronze plans and Keystone HMO Proactive plans only.
6 Members with HSA-qualified and HRA plans will need to meet the plan’s deductible first to receive the low-cost generic benefit. For members with the PPO Bronze HSA-0 $7,450/100%, no cost-sharing applies after meeting the plan’s deductible.
7 Adult and pediatric vision benefits are not subject to a deductible.
8 Independence Blue Cross vision benefits are administered by Davis Vision, an independent company.
9 An affiliate of Independence Blue Cross has a financial interest in Visionworks.
10 Your Hearing Network products and services are made available through your coverage with Davis Vision. Your Hearing Network is not affiliated with Independence Blue Cross, and does not provide Blue Cross or Blue Shield products or services. Your Hearing Network and/or Davis Vision are responsible for these products and services.