Medical, pharmacy, and vision plans
Blue Solutions® health plans for small business 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, and telebehavioral health services from MDLIVE® 1, Magellan2, and participating doctors and specialists who offer these services.
View/Download our 2022 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
Keystone HMO Proactive plans work just like a typical HMO and use a tiered network. Employees must select a PCP in any tier to manage their care and referrals, but they save by choosing providers in the lowest-cost tier. 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.
See how these plans work
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.
See if BlueSaver® accounts work for you
Prescription drug benefits are included in all Blue Solutions medical plans and provide us with a holistic view of members’ health and utilization. This benefit allows us to more effectively coordinate all aspects of members’ health care, which leads to improved outcomes and better control of overall costs.
Our prescription drug benefits, administered by FutureScripts® 4, give your employees access to:
- A large participating network. The network includes more than 68,000 retail and independent pharmacies nationwide.5
- $3 low-cost generics.6 All health plans include a $3 copay for certain generic drugs used to treat chronic conditions such as high cholesterol and high blood pressure.
- Online and mobile tools. In addition to a pharmacy lookup tool, members can access a drug pricing tool at ibx.com and the IBX mobile app. Members can compare prices between pharmacies to help find lower-cost alternatives. Our tools also provide messaging about medication adherence and generic drug availability.
- Mail order. Mail order/home delivery is available, with free shipping, for medications members take regularly. Members may also be able to get a 90-day supply of certain medications for the cost of a 60-day supply.
- 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.
- 90-day maintenance medications available at Rite Aid. Rite Aid pharmacies are now part of the Preferred Pharmacy network (Walgreens pharmacies are no longer included in this network). Members can get a 90-day supply of maintenance medications at Rite Aid retail pharmacies for the same cost-share as mail order.
Pediatric vision is a covered essential health benefit for enrolled members up to age 19. Additionally, our plans include vision benefits for adults, administered by Davis Vision® 7. Employees have access to:
- One routine eye exam per year. Cost is covered in full when using participating providers.
- More than 100,000 access points. Members can choose from an extensive network of independent ophthalmologists and optometrists, as well as retail and online providers, including Visionworks8, Walmart, befitting.com, 1800Contacts.com, and Glasses.com.
- Comprehensive frame and lens coverage. Pediatric members are covered in full for exams and glasses, while adults are covered in full for exams. Plans feature low to no copay on Davis Vision Exclusive Collection frames, or an enhanced frame allowance at Visionworks. Members can also use their plan allowance towards discounted eyewear at Glasses.com, befitting.com or any other in-network providers.
- Quick delivery of contact lenses. In lieu of eyeglasses, members can use their full plan allowance at 1800Contacts.com. One of the most recognized retailers in the industry, 1800Contacts.com features an extensive inventory and 2-click re-ordering.
- Exclusive hearing services. Davis Vision members can also take advantage of a free hearing exam and exclusive discounts on hearing aids, supplies, and more from Your Hearing Network.9
Pediatric dental is a covered essential health benefit for enrolled dependents 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.
We also offer you the option to add comprehensive whole family dental coverage, or adult-only dental benefits, to complement your medical plans.