Medical/Dental/Vision/Rx

Blue Cross and Blue Shield of Alabama is our medical and dental provider.
The plan is a PMD plan which allows participants to seek medical service from any Doctor who participates in the BlueCard Preferred Provider Organization.
Full time employees are eligible to participate in the plan upon hire. Benefits will be effective upon date of hire.
We offer three tiers of coverage: individual, two-person, family.
When you enroll in the plans, you must enroll in both or none. You cannot just enroll in medical or just enroll in dental. However, there will be separate deductions on your paycheck for medical and dental.
Prescription coverage is included as a point-of-sale reimbursement plan.
Routine vision coverage is included in the medical plan.
Eligible dependents for the plan include:
- Your spouse of the opposite sex
- An unmarried child under age 25 who is dependent upon you for more than 50% of support
- An unmarried child up to age 26 while a full time student in a state accredited school, not working full time and chiefly depending on you for support
- An incapacitated child who is not able to support himself and who depends on you for support, if the incapacity occurred before age 19 or 26 if a full time student
The plan runs from June 1 – May 31
The deductible runs from January 1 – December 31
Use the following link to access the Blue Cross Blue Shield website: BCBS.
Click here for a copy of the slides from the Understanding Our Medical Plan presentations.

Medical

The current rates for the medical plan are as follows:
- Individual Coverage - $101.75/month
- Two-person Coverage - $204.50/month
- Family Coverage - $236.75/month
When using an in-network doctor, primary physician office visit co-pay is $25.00. Specialist physician co-pay is $40.00
Annual calendar year deductible is $350/person or $1,050.00 maximum for family.
Pre-certification is required for all hospital admissions except maternity. Emergency admissions require notification within 48 hours of admission.
There is a $150 per day hospital co-pay for days 1-5 for each admission.
In network Outpatient Hospital is subject to a $150 facility co-pay.
Lifetime maximum is $1,000,000.00 for each covered member.
Click here for a copy of the Summary Plan Description for the health plan.
Click here for a short synopsis of the plan.

Prescription Coverage

Prescription drug coverage is offered through a point-of-sale drug program.
Prescription drug benefits are only available for prescriptions purchased from Participating Pharmacies, which are available in all states.
In some cases, drugs may require prior authorization. Your participating pharmacist will advise if this is a requirement.
Prescriptions purchased from Non-Participating Pharmacies are not covered.
Participating Pharmacies give you a number which you must give BCBS when you file your drug claim. This is called the claim authorization number.
You can determine if a pharmacy is participating by going to bcbsal.com.
When purchased at a participating pharmacy, reimbursement schedule is as follows:
- Generic: 100% no deductible
- Preferred Name Brand: 80%, subject to the calendar year deductible
- Non-Preferred Name Brand: 60%, subject to the calendar year deductible
- Specialty: 50%, subject to the calendar year deductible
Reimbursement claims can be made online at BCBSAL.com. This is the fastest way to be reimbursed.
Click here for instructions on how to submit your prescriptions cliams online. *Please note: The instructions ask you to log in to customer access. Customer access is now My Blue Cross For Members.
Claims may also be submitted via mail. Forms are located in Human Resources.

Dental

Current rates for the dental plan are as follows:
- Individual: $7.25/month
- Employee plus one: $13.50/month
- Family: $18.25/month
Coverage is limited to $1,000 per member each calendar year.
There is a $25 calendar year deductible per member each calendar year (three per family)
The deductible does not apply to diagnostic and preventative services
Orthodontic Services are available for dependent children age 19 and under and are covered at 50% subject to the calendar year deductible and the $1,000.00 limit per member each calendar year. It is also limited is a lifetime max of $2,000.00 per member.
Click here for a copy of the Summary Plan Description for the dental plan.
Click here for a short synopsis of the plan.

Vision

Routine vision coverage is included in the medical plan.
Routine vision coverage is covered at 80% of the Allowed Amount, with no deductible
Coverage is limited to $200.00 per person each 24-month period.

COBRA

    • COBRA is the Consolidated Omnibus Reconciliation Act of 1985(Public Law 99-272, Title X).
    • If you are a covered employee, COBRA allows you to temporarily continue coverage under the plan beyond the point at which coverage would otherwise end.
    • COBRA coverage may be offered to each person who is a qualified beneficiary.
    • By law, COBRA benefits are required to be the same as those made available to similarly situated active employees. If the plan changes for active employees, coverage will also change for those covered under COBRA.
    • COBRA premium will be paid by the participant as a rate equal to the full cost of the coverage plus a two-percent administrative fee.   Your cost may change over time, as the cost of benefits under the plan changes.
    • On February 17, 2009, the President signed into law the American Recovery and Reinvestment Act of 2009. The Act generally provides nine months of premium assistance for continuation of coverage required under COBRA and a special election period for those who incurred a loss of coverage due to an involuntary termination from September 1, 2008 through December 31, 2009.
    • For more information regarding the American Recovery and Reinvestment Act of 2009 please click here.

COBRA Rights for Current Employees:
    • If you are a covered employee, you will become eligible for COBRA coverage if you lose coverage under the plan because either one of the following qualifying events occur:
        o Your status changes from full-time to part-time
        o Your employment ends for any reason other than your gross misconduct
    • COBRA coverage will continue for up to a total of 18 months from the date of your termination or employment or reduction in hours, assuming you pay your premiums on time.
    • If your employment ends due to an involuntary termination for any reason other than your gross misconduct, you will be eligible for nine months of premiums assistance for continuation of coverage.

COBRA rights for a Covered Spouse and Dependent Children:
    • If you are covered under the plan as a spouse or a dependent child of a covered employee, your will become eligible for COBRA coverage if you lose coverage under the plan as a result of any of the following events
        o The covered employee dies
        o The covered employee's hours of employment are reduced
        o The covered employee's employment ends for any reason other than his or her gross misconduct
        o Divorce of the covered employee and spouse
        o For a dependent child: the dependent child loses dependent child status under the plan
    • If you are a covered spouse or dependent child, the period of COBRA coverage will generally last up to a total of 18 months in the case of a termination of employment of reduction in hours.
    • If you are a covered spouse or dependent child, the period of COBRA coverage will generally last up to a total of 36 months in the case of divorce, loss of dependent child status, or death of the employee.