Small business medical, pharmacy, and vision plans Blue Solutions® health plans for 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 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.
View/Download our 2020 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. The choice is always theirs to make. Much higher out-of-pocket costs may apply for out-of-network care.
Personal Choice® EPO plans
Exclusive Provider Organization (EPO) plans give your employees access to any doctor or hospital in our PPO network, without requiring a PCP or referrals. EPOs combine the flexibility of a PPO and the cost savings of an HMO.
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 from their participating PCP. Emergency and urgent care access is also available outside the U.S.1 Members pay less for care in the Keystone Health Plan East network, and more when they go out-of-network.
- Must select a participating PCP to coordinate 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.
- Away from Home Care® program 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 with in-network specialists, and only in-network providers are covered except 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 can choose providers in any tier but 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.
High-deductible health plans (HDHPs)
HDHPs offer members the flexibility of a PPO with low 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.
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® 2, give your employees access to:
- A large participating network. The network includes more than 68,000 retail and independent pharmacies nationwide.3
- Rebates at point-of-sale. Applicable drug rebates are provided directly to members with deductibles or coinsurance plans to help reduce out-of-pocket costs.
- 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. Free home delivery is available 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. Members receive support from pharmacists and nurses that treat rare, complex, and chronic diseases.
- 90-day maintenance medications available at Walgreens. Walgreens has been added to the Preferred Pharmacy network and members in all Blue Solutions plans can get a 90-day supply of maintenance medications at Walgreens 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® 4. Employees have access to:
- One routine eye exam per year. Cost is covered in full when using participating providers.
- More than 84,000 access points. Members can choose from an extensive network of optometrists, ophthalmologists, and retail locations, including Visionworks5, Walmart, Sam’s Club, and Costco.
- Comprehensive frame and lens coverage. Pediatric members are covered in full for exams and glasses, while adults are covered in full for exams and have up to $180 frame allowance at Visionworks/$130 frame allowance elsewhere, or $130 contact lens allowance, plus 20 percent of any overage at participating Davis Vision providers.
- Quick delivery of replacement contact lenses. There are low prices on same-day shipping6 for replacement lenses and solutions to most locations from davisvisioncontacts.com.
- Exclusive hearing services. Davis Vision members can also take advantage of discounted hearing services from Your Hearing Network, including a free hearing exam, and up to 40 percent off national average selling prices on brand name hearing aids.7
Pediatric dental benefits
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.
1 Referrals are required for physical/occupational therapy, spinal manipulation, acupuncture, and radiology. For lab work, a member's primary care physician will provide them with a requisition form.
2 FutureScripts is an independent company providing pharmacy benefits management services for Independence Blue Cross.
3 The FutureScripts Preferred Pharmacy network, which includes more than 59,000 retail pharmacies, is included in Silver and Bronze plans and Keystone HMO Proactive plans only.
4 Independence Blue Cross vision benefits are administered by Davis Vision, an independent company.
5 An affiliate of Independence Blue Cross has a financial interest in Visionworks.
6 Shipping is available in the United States, including Hawaii and Alaska. Shipping outside of the 50 states, including Puerto Rico, is not available at this time.
7 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.