ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAE
1
BCBS Basic
BCBS FEP Blue Focus
GEHA StandardGEHA HDHP
Foreign Service Benefit Plan
MHBP HDHPNALC HighBCBS Basic
BCBS FEP Blue Focus
GEHA StandardGEHA HDHP
Foreign Service Benefit Plan
MHBP HDHPNALC High
2
Monthly Premium$515.48$277.75$392.00$397.11$419.74$396.17$457.82Annual Premium$6,185.76$3,333.00$4,704.00$4,765.32$5,036.88$4,754.04$5,493.84
3
Deductible$0.00$1,000.00$700.00$3,000.00$600.00$4,000.00$600.00HSA1,800.002,400.00
4
OOPM$13,000.00$17,000.00$13,000.00$10,000.00$7,000.00$12,000.00$5,000.00
5
Out of Pocket Max$13,000.00$17,000.00$13,000.00$10,000.00$7,000.00$12,000.00$5,000.00Deductible
6
HSA$1,800.00$2,400.00Individual
7
Preventative Care100%100%100%100%100%100%100%Family$0.00$1,000.00$700.00$3,000.00$600.00$4,000.00$600.00
8
Office Visit$30.00$10.0020.005%10%$15.00$25.00CASES
Healthcare Costs
BCBS Basic
BCBS FEP Blue Focus
GEHA StandardGEHA HDHP
Foreign Service Benefit Plan
MHBP HDHPNALC High
9
Specialist$40.00$10.0035.005%10%$15.00$25.00Zero healthcare expensesPremium - HSA$6,185.76$3,333.00$4,704.00$2,965.32$5,036.88$2,354.04$5,493.84
10
Diagnostic (X-ray, Bloodwork)$40.0030%15%5%10%$15.0015%Some healthcare expenses but not enough to reach the deductibleDifference
11
Imaging (MRI)$100.0030%$250.005%10%$15.0015%Meeting GEHA HDHP deductible ($3000 care) exactly on December 31stCost for $3000 care$6,852.43$4,933.00$5,749.00$5,965.32$5,876.88$5,354.04$6,453.84Assuming negotiated doctors visit cost =$180.00
12
OutPatient Surgery$200.0030%15%5%10%$225.0015%More than your deductible but not enough to reach the catastrophic max$6,354.04
*Cost for Plan Deductible if greater than GEHA HDHP Deductible
13
Urgent Care$35.00$25.00$35.005%$35$50.00$25.00Reaching catastrophic max$19,185.76$20,333.00$17,704.00$12,965.32$12,036.88$14,354.04$10,493.84
14
Emergency$250.0030%15%5%10%$50.0015%
15
Hospitalization$1,500.0030%15%5%10%$750.00$350.00Procedure Cases in BrochureBaby$6,535.76$4,943.00$4,774.00$6,025.32$5,036.88$6,414.04$5,498.84
16
Mental Health$30.0030%$20.005%10%$15.0015%(Taken from plan Summary and Benefits Coverage and modified to reflect family deductibles)Diabetes$8,185.76$6,253.00$6,154.00$6,339.72$6,536.88$7,474.04$6,443.84
17
Drugs Generic$15.00$5.00$10.0025%$10.00$10.0020%Simple Fracture$6,985.76$4,833.00$5,564.00$5,765.32$5,746.88$3,754.04$6,193.84
18
Preferred$60.0040%50%25%25%30%30%
19
Non-Preferred$85.0040%50%40%35%30%$200.00
20
Separate Deductible for Drugs?NoNoNoNoNoNoNo
21
Drug Max
22
Separate Drug OOPM$3,100.00
23
24
DentalYesNAYesYesYesNA
25
Check Up$30.00NA50%$0.00$13 off
26
Preventative50%0%
$23-26 off cleaning
27
Resorativelimitedlimited
28
Major
29
OrthodonticNoNoNoNo50%No
30
Ortho Max$1,000.00
31
Vision - Exam$40.00NA$5.00$5.00NANA
32
Contact Exam$40.00
33
Glasses - Base Coverage30%$100.00
34
Glasses - Coinsurance over Base40%80%
35
Lens$50.00$10.00
36
Contacts - Base Coverage$110.00
37
Contacts - Coinsurance over Base85%85%
38
LASIK85%
39
Hearing Aids$2,500.00$2,500.00$4,000.00$1,500.00
40
Period before eligible for replacement (yrs)5335
41
Other BenefitsUp to 10 doctor's visits ($10) copay before deductible applies50 Massages (up to $60 each),
Infertility Treatment
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100