Magnolia Open Access Plan (PPO)

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Administered by Blue Cross Blue Shield

 

The Magnolia Open Access Plan offers coverage both inside and outside of Blue Cross’s nationwide network. It differs from the other Magnolia plans in that members enrolled in the open access plan will not pay co-payments at physician visits. Instead, once a member’s deductible for allowable charges is met, he or she will pay 10% of the allowable amount for in-network care and 30% of the allowable amount for out-of-network care. Out-of-network care may be balance billed.

Though the premiums for the open access plan are higher than OGB’s other plans, its moderate deductibles combined with a nationwide network make it an attractive plan for members who live out of state or travel regularly.

Magnolia Open Access Coverage

Active Employees and non-Medicare retirees - retirement date on or after 3-1-2015

Medical Coverage

  Employee Only Employee +1 (Spouse or Child) Employee + Children Family
Employer Contribution to HRA/HSA $0 $0 $0 $0
Deductible (in-network) $900 $1,800 $2,700 $2,700
Deductible (out-of-network) $900 $1,800 $2,700  $2,700
Out-of-pocket max (in-network) $2,500 $5,000 $7,500 $7,500
Out-of-pocket max (out-of-network) $3,700 $7,500 $11,250 $11,250
Coinsurance (in-network) 10% 10% 10% 10%
Coinsurance (out-of-network) 30%* 30%*  30%*  30%*

 

Prescription Coverage

Tier Member Responsibility Once You Pay $1,500
Generic 50% up to $30 $0 co-pay
Preferred 50% up to $55 $20 co-pay
Non-Preferred 65% up to $80 $40 co-pay
Specialty 50% up to $80 $40 co-pay

*Once a member's deductible for allowable charges is met, he or she will pay 30% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount for out-of-network care.

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see side bar) along with a copy of the invoice to your health insurance carrier. BCBS will then reimburse you according to the plan's guidelines.