Medical Plans
BlueCross BlueShield of Alabama
For Middleport Union
You have the option to enroll yourself and your eligible dependents in a Preferred Provider Organization (PPO) offered through BlueCross BlueShield of Alabama. This plan includes Prescription Drug coverage options.
With the PPO, when you receive care in-network you benefit from our negotiated discounts and greater plan coverage for medical services. Additionally, you will pay a copay for primary care visits to your doctor, as well as for telemedicine, specialist treatment and urgent care. Preventive care is covered 100%, as long as you are treated by an in-network provider.
Medical Contact Information
BlueCross BlueShield of Alabama
- Find network providers, facilities and pharmacies: bcbsal.org
- Call: 800.783.2197
CVS
- Visit: caremark
- Call: 800.552.8159
- CVS Caremark Participating National Network Retail Pharmacy list
- CVS Pharmacy Locator
- CVS Check Prescription Drug Cost (PPO)
- Preventive Drug List
- Advanced Control Specialty Formulary
- CVS Formulary
Additional Information
Plan Details
| BlueCross BlueShield of Alabama PPO | ||
|---|---|---|
| In-Network | Out-Of-Network | |
| Calendar Year Deductible | ||
| Individual | $250 | $500 |
| Family | $500 | $1,000 |
| Out-of-Pocket Maximum (includes deductible) | ||
| Individual | $1,100 | $2,200 |
| Family | $2,200 | $4,400 |
| Hospital Services | ||
| Inpatient | Deductible then 10% coinsurance | Deductible then 30% coinsurance |
| Outpatient | Deductible then 10% coinsurance | Deductible then 30% coinsurance |
| Office Visits | ||
| Preventive Care | 100% covered | Deductible then 30% coinsurance |
| Primary Care Physician | $10 copay | Deductible then 30% coinsurance |
| Specialist | $10 copay | Deductible then 30% coinsurance |
| Urgent Care | $10 copay | |
| Emergency Room | Deductible then 10% coinsurance | |
| Prescription Drugs | ||
| Retail (30-day supply) | ||
| Tier 1 | 20% coinsurance* | 20% coinsurance* |
| Tier 2 | 20% coinsurance* | 20% coinsurance* |
| Tier 3 | 20% coinsurance* | 20% coinsurance* |
| Mail Order (90-day supply) | ||
| Tier 1 | 20% coinsurance* | Not applicable |
| Tier 2 | 20% coinsurance* | Not applicable |
| Tier 3 | 20% coinsurance* | Not applicable |
* Not subject to calendar year deductible
This is a summary of coverage. Full coverage details are available in your Summary Plan Description (SPD) or official Plan Documents. In the event there are differences between this summary and your official Plan Documents, your Plan Documents prevail.