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Medical Insurance - CareFirst Administrators
Schuster offers two medical plan options. Each plan accesses the National BlueCross BlueShield provider
networks. The chart below is a brief outline of the Standard plan. Please refer to the Summary Plan Description for
complete plan details.
NOTE: Medical benefit deductions are taken on a pre-tax basis.
BENEFITS
VALUE 70/50 PLAN
In-Network
Out-of-Network
Annual Deductible (calendar year)
Individual
$1,500
$3,000
Family
$3,000
$6,000
Maximum Out of Pocket (calendar year)
Includes deductible
Individual
$3,000
$6,000
Family
$6,000
$12,000
Preventive Care
Immunizations
100%
50% after deductible
Preventive Care
100%
50% after deductible
Physician Services
Office Visits
70% after deductible
50% after deductible
Specialist Visits
70% after deductible
50% after deductible
Urgent Care
70% after deductible
50% after deductible
Outpatient Diagnostic
Diagnostic Tests Minor
70% after deductible
50% after deductible
Diagnostic Tests Major
70% after deductible
50% after deductible
Hospital Services
Inpatient Care (pre-certification required)
70% after deductible
50% after deductible
Outpatient Surgery
70% after deductible
50% after deductible
Emergency room
50% after deductible
Prescription Drugs—with Express Scripts
RX Deductible
$250/individual/$500 family
RX Out-of-Pocket Max
None
Retail Generic
$10
Retail Preferred
$30
Retail Non Preferred
$50
Specialty Drugs
15% Coinsurance up to $150 Max Per Fill
Retail/Mail Prescription
Retail - 34 day supply; Mail - 90 day supply; copay 2x retail
Smoking Cessation Products
$500/individual per lifetime