GVEC provides an extensive benefits package for you and your covered dependents. Selecting the right benefits provides comfort knowing that you’re covered in the event of an unexpected illness or injury. All employees (working 30 or more hours per week) are eligible to enroll in benefits on the 89th day of employment.
Traditional Low Plan (PPO) – Group #072037
BlueCross BlueShield of TX
| In-Network | Out-of-Network | |
|---|---|---|
| Deductible per Calendar Year | ||
| Individual | $750 | $2,250 |
| Family | $2,250 | $6,750 |
| Out-of-Pocket Maximum per Calendar Year | ||
| Individual | $2,750 | $8,250 |
| Family | $6,000 | $18,000 |
| Emergency Care | ||
| Emergency Room | $200 Copay plus 20% Coinsurance (copay waived if admitted and deductible applies to physician charges) | |
| Hospital Care | ||
| Inpatient | Deductible then 20% Coinsurance | Deductible then 50% Coinsurance |
| Office Visits | ||
| PCP | $30 Copay | Deductible then 50% Coinsurance |
| Specialist | $40 Copay | Deductible then 50% Coinsurance |
| Urgent Care | $50 Copay | Deductible then 50% Coinsurance |
| Prescription Drug Program | ||
| Generic | $5 Copay | $5 Copay |
| Preferred Brand | $35 Copay | $35 Copay |
| Non-Preferred Brand | $60 Copay | $60 Copay |
| Specialty Rx | 20% up to $250 max/Rx | 20% up to $250 max/Rx |
| Mail Order Rx (90-day supply) | $10 / $70 / $120 Copay | Not Available |
| Per Pay Period Contributions | ||
| Employee Only | $141.46 | |
| Employee + One | $352.09 | |
| Employee + Two or more | $379.91 | |