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RETA / Blue Cross Blue Shield of California
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Frequently Asked QuestionsMedical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit blueshieldca.com.
In-Network Only |
|
|---|---|
Deductible |
$750 / $1,500 |
Out-of-Pocket Max |
$4,000 / $8,000 |
Member Coinsurance (Plan pays/Member pays) |
90 % / 10% |
Physician Visits |
|
Primary Care |
$25 Copay |
Routine Preventive |
No Charge |
Specialist |
$40 Copay |
Telehealth |
$25 Copay |
Hospital Services |
|
Physician Services |
Deductible + 10% Coinsurance |
Inpatient Hospitalization |
Deductible + 10% Coinsurance |
Outpatient Surgery |
Deductible + 10% Coinsurance |
Basic Outpatient Diagnostics |
Deductible + 10% Coinsurance |
Urgent Care |
$50 Copay |
Emergency Room |
$200 Copay + 10% Coinsurance |
Retail Prescriptions |
|
Tier 1 - Generic |
$10 Copay |
Tier 2 - Preferred Brand |
$25 Copay |
Tier 3 - Non-preferred Brand |
$45 Copay |
Tier 4 - Specialty |
$45 Copay |
Mail Order Prescriptions |
|
Tier 1 - Generic |
$20 Copay |
Tier 2 - Preferred Brand |
$50 Copay |
Tier 3 - Non-preferred Brand |
$90 Copay |
For Employee & Spouse coverage there will be a $150 surcharge if the spouse has health coverage available to them. If they do not have coverage available to them, there will be no surcharge. |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit blueshieldca.com.
In-Network Only |
|
|---|---|
Deductible |
$1,500 / $3,000 |
Out-of-Pocket Max |
$6,000 / $12,000 |
Member Coinsurance (Plan pays/Member pays) |
80% / 20% |
Physician Visits |
|
Primary Care |
$25 Copay |
Preventive Care |
No Charge |
Specialist |
$40 Copay |
Telehealth |
$25 Copay |
Hospital Services |
|
Physician Services |
Deductible + 20% Coinsurance |
Inpatient Hospitalizaation |
Deductible + 20% Coinsurance |
Outpatient Surgery |
Deductible + 20% Coinsurance |
Basic Outpatient Diagnostics |
Deductible + 20% Coinsurance |
Urgent Care |
$75 Copay |
Emergency Room |
$200 Copay + 20% Coinsurance |
Retail Prescriptions |
|
Tier 1 - Generic |
$10 Copay |
Tier 2 - Preferred Brand |
$30 Copay |
Tier 3 - Non-preferred Brand |
$50 Copay |
Tier 4 - Specialty |
$50 Copay |
Mail Order Prescriptions |
|
Tier 1 - Generic |
$20 Copay |
Tier 2 - Preferred Brand |
$60 Copay |
Tier 3 - Non-preferred Brand |
$100 Copay |
For Employee & Spouse coverage there will be a $150 surcharge if the spouse has health coverage |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit blueshieldca.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$3,000 / $6,000 |
$3,000 / $6,000 |
Out-of-Pocket Max |
$7,000 / $14,000 |
$7,000 / $14,000 |
Member Coinsurance (Plan pays/Member pays) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
20% after Deductible is met |
40% after Deductible is met |
Preventive Care |
No Charge |
40% after Deductible is met |
Specialist |
20% after Deductible is met |
40% after Deductible is met |
Telehealth |
$55 per visit until Deductible is met |
$55 per visit until Deductible is met |
Hospital Services |
||
Physician Services |
20% after Deductible is met |
40% after Deductible is met |
Inpatient Hospitalization |
20% after Deductible is met |
40% after Deductible is met |
Outpatient Surgery |
20% after Deductible is met |
40% after Deductible is met |
Basic Outpatient Diagnostics |
20% after Deductible is met |
40% after Deductible is met |
Urgent Care |
20% after Deductible is met |
40% after Deductible is met |
Emergency Room |
20% after Deductible is met |
40% after Deductible is met |
Retail Prescriptions |
||
Tier 1 - Generic |
$10 Copay after Deductible |
Not Covered |
Tier 2 - Preferred Brand |
$20 Copay after Deductible |
Not Covered |
Tier 3 - Non-preferred Brand |
$40 Copay after Deductible |
Not Covered |
Tier 4 - Specialty |
$40 Copay after Deductible |
Not Covered |
Mail Order Prescriptions |
||
Tier 1 - Generic |
$20 Copay after Deductible |
Not Covered |
Tier 2 - Preferred Brand |
$40 Copay after Deductible |
Not Covered |
Tier 3 - Non-preferred Brand |
$80 Copay after Deductible |
Not Covered |
For Employee & Spouse coverage there will be a $150 surcharge if the spouse has health coverage |
Copayment and/or coinsurance is determined by the tier to which the Prescription Drug List (PDL) Management Committee has assigned the Prescription Drug Product. All Prescription Drug Products on the CVS Caremark Preferred Rx List are assigned as one of the four tiers.
Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.caremark.com.
Medicare Part D
The prescription drug benefit is creditable coverage. Medicare eligible participants need not enroll in a separate Medicare Part D drug plan.
Rx Mail Order Program
Save time and money by filling maintenance drugs through the mail order program. The Mail Order Program benefits members who are on long-term medications for chronic conditions such as diabetes, high cholesterol, high blood pressure, depression or asthma. By utilizing the Mail Order Program, you can receive a 90-day supply of medication for the equivalent of two retail copayments. That’s a savings of one copayment for every 90-day supply.
We encourage you to visit www.blueshieldca.com for locating providers, reviewing covered prescriptions, monitoring the status of claims, and for viewing your Member ID Card.
1. Visit blueshieldca.com and click Find a Doctor in the top toolbar.
2. Enter the zip code of the location you would like to search, then select find out-of-state care.
3. Click Find Care and Continue.
4. Click Choose location and Plan, enter your zip code again and click Yes, this is correct.
5. Type the following 3 letters for the Plan Prefix: REA
6. Search by Doctor Name, Specialty or Facility.
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Provided By
RETA / Blue Cross Blue Shield of California
Provider Website
Customer Service
Resources
Frequently Asked Questions