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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > Rhode Island > Plan Profile: Blue Chip, Coord Hlth Partners

General Information
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Plan Name: Blue Chip, Coord Hlth Partners
Service Area: All of Rhode Island
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: Yes
JCAHO Accreditation: No
URAC Accreditation: No
Plan Type: POS
Enrollment Code-Self: DA1
Enrollment Code-Self & Family: DA2
Link to Plan Home Page: http://www.bcbsri.com
Telephone: 401/459-5500
Summary results of the 2001 consumers assessment of health plans survey
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Benefits
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In Network - Doctor Care/ Primary Office Visits: $10
In Network - Hospital Inpatient Room and Board Charges: None
In Network - RX/ Generic/ Retail: $5
In Network - RX/ Brand/ Retail: $15
In Network - RX/ Brand/ NonFormulary: $30
Out of Network - Doctor Care/ Primary Office Visits: 20%
Out of Network - Hospital Inpatient Room and Board Charges: None
Out of Network - RX/ Generic/ Retail: $30 + 20%
Out of Network - RX/ Brand/ Retail: $30 + 20%
Out of Network - RX/ Brand/ NonFormulary: $30 + 20%
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Rates
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Non-Postal
___Twice Biweekly Self: $67.10 Self: & Family: $226.10
___Monthly Self: $72.69 Self: & Family: $244.94
___Biweekly Self: $33.55 Self: & Family: $113.05
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Annuitants
___Monthly Self: $72.69 Self: & Family: $244.94
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U.S. Postal Service Employees (Type A)
___Biweekly Self: $15.89 Self: & Family: $72.71
___Monthly Self: $34.43 Self: & Family: $157.54
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U.S. Postal Service Employees (Type B)
___Monthly Self: $48.05 Self: & Family: $219.53
___Biweekly Self: $22.18 Self: & Family: $101.32
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Worker's Compensation Recipients
___Twice Biweekly Self: $67.10 Self: & Family: $226.10
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Certain Temporary Employees
___Biweekly Self: $131.41 Self: & Family: $336.46
___Monthly Self: $284.72 Self: & Family: $729.00
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Former Spouse Enrollees
___Biweekly Self: $131.41 Self: & Family: $336.46
___Monthly Self: $284.72 Self: & Family: $729.00
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Temporary Continuation of Coverage
___Monthly Self: $290.41 Self: & Family: $743.58
___Biweekly Self: $134.04 Self: & Family: $343.19
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FDIC
___Biweekly Self: $15.89 Self: & Family: $72.71
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