BlueCHOICE - St. Clair And Madison Counties

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General Information

Plan Name:	BlueCHOICE
Service Area:	St. Clair And Madison Counties
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	Yes
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	HMO
Enrollment Code-Self:	9G1
Enrollment Code-Self & Family:	9G2
Link to Plan Home Page:	http://www.bcbsmo.com
Telephone:	800/634-4395

Benefits

Doctor Care/ Primary Office Visits:	$10.00
Hospital Inpatient Room and Board Charges:	None
RX/ Generic/ Retail:	$5.00
RX/ Brand/ Retail:	$10.00
RX/ Brand/ NonFormulary:	$15.00

Rates

Non-Postal
___Monthly	Self: $66.45	Self: & Family: $143.85
___Biweekly	Self: $30.67	Self: & Family: $66.39
___Twice Biweekly	Self: $61.34	Self: & Family: $132.78
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Annuitants
___Monthly	Self: $66.45	Self: & Family: $143.85
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U.S. Postal Service Employees (Type A)
___Biweekly	Self: $13.80	Self: & Family: $29.88
___Monthly	Self: $29.90	Self: & Family: $64.73
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U.S. Postal Service Employees (Type B)
___Monthly	Self: $29.90	Self: & Family: $65.95
___Biweekly	Self: $13.80	Self: & Family: $30.44
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Worker's Compensation Recipients
___Twice Biweekly	Self: $61.34	Self: & Family: $132.78
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Certain Temporary Employees
___Biweekly	Self: $122.67	Self: & Family: $265.58
___Monthly	Self: $265.79	Self: & Family: $575.42
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Former Spouse Enrollees
___Biweekly	Self: $122.67	Self: & Family: $265.58
___Monthly	Self: $265.79	Self: & Family: $575.42
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Temporary Continuation of Coverage
___Biweekly	Self: $125.12	Self: & Family: $270.89
___Monthly	Self: $271.11	Self: & Family: $586.93
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FDIC
___Biweekly	Self: $13.80	Self: & Family: $29.88
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