Medical Insurance

The rising cost of health care continues to make it harder to find affordable medical benefits. Our goal is to offer affordable benefit options that also ensure you have access to high-quality services.  ER Hospitals offers employees two medical plan options: the traditional Point of Service (POS) Plan and the High Deductible Health Plan (HDHP) with a Health Savings Account, both of which are insured through Blue Cross Blue Shield of Georgia (BCBSGA).  Both plans include in and out-of-network coverage.  You may obtain information on plan benefits and check the status of a claim by visiting www.bcbsga.com.

The Point of Service Plan includes preventive care, emergency, mental health and prescription coverage as part of the medical plan election.  The deductible is $4,000 for individual coverage and $12,000 for family.  The POS plan includes copays for several services and pays at 80% after the deductible is met for others.  In-network preventive care is covered at 100%.

The High Deductible Plan with the Health Savings Account (HSA) (see details below) also includes preventive care, emergency, mental health and prescription coverage as part of the medical plan election.  The deductible is $4,000 for individual coverage and $8,000 for family.  The plan pays 70% for most services after the deductible is met.  In-network preventive care is covered at 100%.

Health Savings Account (HSA)

HSAs are available to all individuals who are covered by a qualified high-deductible health plan (HDHP).  An HSA is designed to pay for routine health expenses and/or provide savings for the future.  Money put into the account can be used either during the year or accumulated in the account.  You can contribute to your HSA through payroll deduction, up to the maximum amount allowed by the IRS.  Employees with individual coverage can contribute up to $3,500 and employees with family coverage can contribute up to $7,000 on a pre-tax basis.  Individuals age 55 or older may be eligible to make catch-up contributions of $1,000 per year.

The information contained in this presentation is an overview of your benefits. If you have specific questions regarding a provider or procedure, please call BCBS Customer Service at the number listed on the back of your ID Card. If you do not have an ID card, please call (855) 397-9267 or refer to the Medical & Rx SPD.

BCBS HSA (Health Savings Account) Plan

In-Network Out-of-Network
Deductible (Calendar Year)
Single $4,000 $12,000
Family $8,000 $24,000
Lifetime Maximum Unlimited Unlimited
Coinsurance (Plan/Member) 70% / 30% 50% / 50%
Max Out-of-Pocket (Including Deductible)
Single $6,750 $20,250
Family $13,500 $40,500
Hospital Facility Services
Inpatient Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Outpatient Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Emergency Room Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Physician Office Visits
Primary Care Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Specialist Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Urgent Care Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Prescription Drug Coverage*
Generic Drugs Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Preferred Drugs Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Brand Drugs Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Specialty Drugs Plan Pays 70% after Deductible Plan Pays 50% after Deductible
Mail Order Plan pays 70% after Deductible Not Covered

* Please refer to the benefit summary for Rx Tier descriptions

BCBS PPO Plan

In-Network Out-of-Network
Deductible (Calendar Year)
Single $4,000 $12,000
Family $12,000 $36,000
Lifetime Maximum Unlimited Unlimited
Coinsurance (Plan/Member) 80% / 20% 50% / 50%
Max Out-of-Pocket (Including Deductible)
Single $7,900 $23,700
Family $15,800 $47,400
Hospital Facility Services
Inpatient Plan Pays 80% after Deductible Plan Pays 50% after Deductible
Outpatient Plan Pays 80% after Deductible Plan Pays 50% after Deductible
Emergency Room $150 Copay, then 20% $150 Copay, then 20%
Physician Office Visits
Primary Care $25 Copay Plan Pays 50% after Deductible
Specialist $50 Copay Plan Pays 50% after Deductible
Urgent Care $60 Copay Plan Pays 50% after Deductible
Prescription Drug Coverage*
Generic Drugs $15 Copay Plan Pays 50% after Deductible
Preferred Drugs $45 Copay Plan Pays 50% after Deductible
Brand Drugs $85 Copay Plan Pays 50% after Deductible
Specialty Drugs 20% to max $300 Plan Pays 50% after Deductible
Mail Order (90 day supply) $15/$90/$255/20% up to $300 Not Covered

* Please refer to the benefit summary for Rx Tier descriptions

Medical Payroll Deductions

Medical – BCBS HSA Plan Total Monthly Premium Employee Contribution Per Check Employee Tobacco* Contribution Per Pay Check
Employee Only $550.99 $89.01 $119.01
Employee + Spouse $1157.06 $186.91 $216.91
Employee + Children $1074.43 $173.56 $216.19
Family $1680.51 $271.47 $301.47
Medical – BCBS PPO Plan Total Monthly Premium Employee Contribution Per Check Employee Tobacco* Contribution Per Pay Check
Employee Only $631.38 $126.11 $156.11
Employee + Spouse $1325.89 $264.83 $294.83
Employee + Children $1231.18 $245.91 $275.91
Family $1925.71 $384.64 $414.64

Finding Providers

How do you find an in-network provider?  It’s easy!

  1. Go to www.bcbsga.com.
  2. Under the Individual & Family tab, click Find a Doctor (under Care section).
  3. You can search for a provider as a Member (if you are enrolled & have your ID card) or as a Guest.
  4. Select the Blue Open Access POS network to find a doctor.
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