Medical Plans
BlueCross BlueShield of Alabama
For Kato 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 | $600 per person | $1,200 per person |
| Family | $1,200 per family | $1,200 per person |
| Out-of-Pocket Maximum (includes deductible) | ||
| Individual | $5,200 | $13,275 per person |
| Family | $12,700 | $13,275 per person |
| Hospital Services | ||
| Inpatient | Deductible then 20% coinsurance | Deductible then 40% coinsurance |
| Outpatient | Deductible then 20% coinsurance | Deductible then 40% coinsurance |
| Office Visits | ||
| Preventive Care | 100% covered | Not covered |
| Primary Care Physician | $35 copay | Deductible then 40% coinsurance |
| Specialist | Deductible then 20% coinsurance | Deductible then 40% coinsurance |
| Urgent Care | $35 copay | Deductible then 40% coinsurance |
| Emergency Room | $200 copay then deductible then 20% coinsurance | |
| Prescription Drugs | ||
| Retail (30-day supply) | ||
| Tier 1 | You pay greater of $10 or 10% up to $40 maximum | Not covered |
| Tier 2 | You pay greater of $30 or 25% up to $100 maximum | Not covered |
| Tier 3 | You pay greater of $60 or 35% up to $400 maximum | Not covered |
| Mail Order (90-day supply) | ||
| Tier 1 | You pay greater of $25 or 10% up to $100 maximum | Not applicable |
| Tier 2 | You pay greater of $75 or 25% up to $250 maximum | Not applicable |
| Tier 3 | You pay greater of $150 or 35% up to $1,000 maximum | Not applicable |
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.