HMO Blue - Utica/Rome/Central New York areas

You are here: FEHB Home > 2002 Plan Comparison > New York > Plan Profile: HMO Blue

General Information

Plan Name:	HMO Blue
Service Area:	Utica/Rome/Central New York areas
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	Yes
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	HMO
Enrollment Code-Self:	AH1
Enrollment Code-Self & Family:	AH2
Link to Plan Home Page:	http://www.bcbsuw.com
Telephone:	800/722-7884
Summary results of the 2001 consumers assessment of health plans survey

Benefits

Doctor Care/ Primary Office Visits:	$10
Hospital Inpatient Room and Board Charges:	None
RX/ Generic/ Retail:	$5
RX/ Brand/ Retail:	$20
RX/ Brand/ NonFormulary:	$35

Rates

Non-Postal
___Twice Biweekly	Self: $61.88	Self: & Family: $187.08
___Monthly	Self: $67.03	Self: & Family: $202.67
___Biweekly	Self: $30.94	Self: & Family: $93.54
_
Annuitants
___Monthly	Self: $67.03	Self: & Family: $202.67
_
U.S. Postal Service Employees (Type A)
___Monthly	Self: $30.16	Self: & Family: $115.27
___Biweekly	Self: $13.92	Self: & Family: $53.20
_
U.S. Postal Service Employees (Type B)
___Monthly	Self: $31.46	Self: & Family: $177.26
___Biweekly	Self: $14.52	Self: & Family: $81.81
_
Worker's Compensation Recipients
___Twice Biweekly	Self: $61.88	Self: & Family: $187.08
_
Certain Temporary Employees
___Biweekly	Self: $123.75	Self: & Family: $316.95
___Monthly	Self: $268.13	Self: & Family: $686.73
_
Former Spouse Enrollees
___Biweekly	Self: $123.75	Self: & Family: $316.95
___Monthly	Self: $268.13	Self: & Family: $686.73
_
Temporary Continuation of Coverage
___Monthly	Self: $273.49	Self: & Family: $700.46
___Biweekly	Self: $126.23	Self: & Family: $323.29
_
FDIC
___Biweekly	Self: $13.92	Self: & Family: $53.20
_