Medical and Pharmacy Coverage
Brookstone School offers the following Medical plans through Anthem BlueCross BlueShield and offers “in and out-of-network” benefits. Insurance Carrier:
Anthem BlueCross BlueShield Medical Insurance
Medical Plan:
$2,500 / 80% Coinsurance Plan
In-Network: Office Visit Copay - Primary Care Office Visit Copay - Specialist Care
$30 $60 $75
Urgent Care Copay Emergency Room Care Preventative Visit Copay
$350; then 20% Coinsurance
$0
Diagnostic Testing & Blood Work
$60
Imaging
20% Coinsurance
Coinsurance
80%
Employee Deductible Family Deductible
$2,500 $7,500 $7,900 $15,800
Employee Out-of-Pocket Max Family Out-of-Pocket Max
Inpatient Hospital
20% Coinsurance
Outpatient Hospital or Facility
$30
Out-of-Network: Coinsurance Employee Deductible
50%
$7,500 $22,500 $23,700 $47,400
Family Deductible
Employee Out-of-Pocket Max Family Out-of-Pocket Max
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$15 $35 $60
Tier 2 - Preferred
Tier 3 - Non-Preferred
Tier 4 - Specialty
25% Coinsurance up to $350
Employee Monthly Deduction Employee Only
$284.83
$588.02* (+ $250 if spouse is eligible for coverage through their employer)
Employee + Spouse*
Employee + Child(ren)
$546.51
$853.87 (+ $250 if spouse is eligible for coverage through their employer)
Family*
4 BROOKSTONE SCHOOL 2023 BENEFITS GUIDE
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