Orange County NC Website
Browse       Search
r <br /> Benefits Changes <br /> Blue Cross PCP, Blue Care Plan 1 and Blue Care Plan 2 <br /> Services Personal Care Plan (PCP) Option 1 - Blue Care Plan 1 Options 2 & 3 - Blue Care Plan <br /> Primary Care Physician or OBGYN must Open Access (No referral required within Open Access (No referral required within <br /> General authorize referral network) network) <br /> Deductibles <br /> Individual (per calendar year) $0 $0 $250 (For designated services) <br /> Family(per calendar year) $0 $0 $750 (For designated services) <br /> Physician Services <br /> Office Visits-Primary $10 Copay $10 Copay $10 Copay <br /> Office Visits-Specialists $10 Copay $20 Copay $20 Copay <br /> Urgent Care Office Visit $25 Copay $20 Copay $20 Copay <br /> After Hours Visit $25 Copay $10 Copay PMD; $20 Specialist $10 Copay PMD; $20 Specialist <br /> Prenatal/Postpartum Office Care $10 Copay Per Pregnancy $10 Copay PMD; $20 Specialist $10 Copay PMD; $20 Specialist <br /> Short Term Therapy(Speech, <br /> Occupational, Respiratory, and $10 Copay- Maximum of 30 Visits Per $10 Copay PMD, $20 Copay Specialist : $10 Copay PMD, $20 Copay Specialist : <br /> Physical) Calendar Year Maximum of 20 Visits Per Cal Yr Maximum of 20 Visits Per Cal Yr <br /> Preventive Care <br /> Routine Physicals $10 Copay $10 Copay PMD; $20 Specialist $10 Copay PMD; $20 Specialist <br /> Well Child Care $10 Copay $10 Copay PMD; $20 Specialist $10 Copay PMD; $20 Specialist <br /> Immunizations, Prostate Specific <br /> Antigen Tests, Mammograms, <br /> Pap Smears 100% $10 Copay PMD; $20 Specialist $10 Copay PMD; $20 Specialist <br /> Emergency Room Care $50 Copay $100 Copay $100 Copay <br /> Hospital Services <br /> Per Confinement Deductible None None None <br /> Inpatient Professional 100% 100% 100% after deductible <br /> Inpatient Facility 100% 100% 100% after deductible <br /> Outpatient-X-Rays and Lab with <br /> surgery or other services 100% 100% 100% after deductible <br /> Outpatient-X-rays & Lab without <br /> surgery or other services 100% 100% 100% <br /> Maternity(Hosp Services) 100% 100% 100% after deductible > <br /> Ambulatory Surgical Facility 100% $75 Copay $75 Copay <br /> Prescription Drugs <br /> Tier 1 $6 Copay; Tier 2 $12 Copay; Tier 3 Tier 1 $5 Copay; Tier 2 $15 Copay; Tier 3 Tier 1 $10 Copay;Tier 2 $20 Copay; Tier 3 <br /> Short Term Supply $18 Copay(1-34 Day Supply) $30 Copay(1-30 Day Supply) $30 Copay(1-30 Day Supply) <br /> healpcpcomp10/3/2002 <br />