Blue Cross small group plan Comparison

July 1, 2010 through June 30, 2011

Dual Choice Grid

Price Factor Table

Six plan families, offering more plans, more price points and better cost control.

Plan name   In-network deductibles, coinsurance and copays Deductibles Out of pocket maximum (in network) Coinsurance Copay options Office visits or urgent care visits Retail health clinic visits Access Aware® network, our broadest statewide network Accord network, our most affordable statewide network Value network, our new metro-based network Pharmacy benefits Prescription drug copays Specialty drugs

The special advantages of Blue Cross small group plans All of these plans cover preventive care at 100 percent and have a $5 million lifetime maximum benefit. With all of our plans, you can purchase preventive care and comprehensive dental plan options, as well as life and disability plans. All of these plans also include fourth quarter deductible carryover, which means that members who haven’t met their calendar-year deductible can carry over expenses from October, November and December and apply them to their next year’s deductible. Options Blue HSA and HRA, when administered by SelectAccountSM, offer automatic reimbursement of claims. MII Life Inc., d.b.a. SelectAccount, is an independent company providing account administration services

A note about Freedom 1-2-3 Recent Minnesota law changed the rules to allow health plans to exclude or modify certain mandated coverage. Freedom 1-2-3 was created as a “mandatelight” health plan. This plan excludes bariatric surgery, infertility/assisted reproduction, services from a doctor of chiropractic, services for behavioral health, mental health and chemical dependency/substance abuse. This is only an outline of plan benefits. The contract and certificate include complete details of what is and isn’t covered. Benefits are effective July 1, 2009 through June 30, 2010.