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Plan Comparison Chart – Choose the plan that fits you best.

Participating Provider Coverage Shown1



Individual & Family Products
  • Blue Care Connection
  • Simply Blue
  • Blue Transitions
  • BlueCare Dental Product
  • BlueSelect Dental and BlueSelect Childrens Dental
  • Health Check Basic
  • Health Check HSA
  • Health Check Select

Health Check Select benefits:

  • Rates based upon individual needs
  • $15 copay for most routine doctor's office visits
  • Large network of health care providers to choose from
  • Six deductible options, ranging from $200 to $5,000
  • Optional maternity benefits
  • Lower rates for non-tobacco users

For more information on Health Check Select and the Health Check family of plans, download a product guide brochure.

Health Check Basic benefits:

  • Rates based upon individual needs
  • $35 copay for most routine doctor's office visits
  • Large network of health care providers to choose from
  • Four deductible options, ranging from $500 to $5,000
  • Optional maternity benefits
  • Lower rates for non-tobacco users

For more information on Health Check Basic and the Health Check family of plans, download a product guide brochure.

HSA
Quality, individual health coverage combined with money-saving tax advantages

Blue Cross and Blue Shield quality coverage combined with a tax-deductible health savings account: that's Health Check HSA.

Health Check HSA from Blue Cross and Blue Shield of Oklahoma is a health coverage plan Oklahomans can buy individually - without belonging to an employer group. And the plan is intended to meet federal guidelines for use with a federally qualified health savings account (HSA). So, with Health Check HSA, your clients have a health coverage plan that allows them to open a health savings account with a qualified financial institution and benefit from the money-saving tax advantages the account provides.

Because it's from Blue Cross and Blue Shield of Oklahoma, they know Health Check HSA is a quality health insurance plan. It's also affordable: Blue Cross and Blue Shield of Oklahoma combines checking account holders at participating Oklahoma banks, credit unions and savings and loans - pooling them together - and providing individuals and families with group benefits at competitive, group-type rates.

With Health Check HSA, your client's membership belongs to them, not an employer. Even if they change jobs, they don't have to give up their health care benefits.

 
Simply Blue
 
   
  Annual deductible options
$1,000 $2,000 $3,000
$5,000 $7,500 $10,000
 
  Health care provider networks and coinsurance amounts. Most covered services are paid at the following amounts after you meet your annual deductible. BlueChoice PPO network: 70%
Out-of-network: 50%
 
  Doctor’s office copayment $40 copayment  
  Hospital inpatient
per-occurrence deductible
$500 per occurrence  
  Individual stop-loss limits/
out-of-pocket expense
$10,000 stop-loss limit during the year for covered services.  
  Prescription drug coverage $10 Generic, 50% preferred brand, 100% member-pay on non-preferred brand.5  
  Prescription Drug
Utilization/Benefit Management Programs
Not Applicable  
  Emergency room
per-occurrence deductible
$200  
  Facility outpatient per-occurrence deductible
(for surgical procedures)
$200  
  Preventive care benefit 100%  
     

 
HealthCheck Select
 
HealthCheck Basic
 
HealthCheck HSA
2
 
   
 
$200 $500 $1,000
$1,500 $2,500 $5,000
 
$500 $1,000 $2,500
$3,500 $5,000 $7,500
 
Individual
$1,500 $2,500 $3,500 $5,000
Family
$3,000 $5,000 $7,000 $10,000
 
  BlueChoice PPO network: 80%
BlueTraditional network: 70%
Out-of-network: 70%
  BluePreferred PPO network: 80%
BlueChoice PPO network: 70%
BlueTraditional network: 60%
Out-of-network: 50%
  BlueChoice PPO network: 80%3
BlueTraditional network: 60%
Out-of-network: 60%
 
  $15 for most visits to a BlueChoice PPO network, not subject to deductible.   $35 for most visits, not subject to deductible   The money the individual or family places in the HSA account can be used to pay charges subject to deductible and coinsurance.  
  None for BlueChoice PPO network admissions. $300 for BlueTraditional or out-of-network admissions.   $500 per occurrence   The money the individual or family places in the HSA account can be used to pay charges subject to deductible and coinsurance.  
  $1,000 out-of-pocket expense limit during the year for covered services received from BlueChoice PPO network providers.4   $2,500 out-of-pocket expense limit during the year for covered services. A separate $10,000 out-of-pocket expense limit applies for prescription drug coverage.   Out-of-pocket expense limit depends upon the annual deductible option chosen. See the plan brochure for additional information.  
  After you meet your annual deductible, benefits are paid at 70% of allowable charges when you use network pharmacies.   Begins immediately at 50% of allowable charges when you use a network pharmacy.6   After you meet your annual deductible, benefits are reimbursed at 70% of allowable charges when you use network pharmacies. 3  
  Dispensing Limits: Benefits include coverage limits on certain medications. These limits are based on approved guidelines.
Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSOK and/or certain criteria must be met.
Specialty Pharmacy Program: Specialty medications must be received through the preferred Specialty Pharmacy Provider.
Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost.
 
  None   $100   The money the individual or family places in the HSA account can be used to pay charges subject to deductible and coinsurance.  
  None   $200   The money the individual or family places in the HSA account can be used to pay charges subject to deductible and coinsurance.  
  100%   100%   100%  
           
1 Benefits reduced when non-participating providers are used. This is not a contract. It is a summary of highlights only. Please refer to the Outline of Coverage for each plan for additional details.
2 As a reminder, Health Savings Accounts (HSA) have tax and legal ramifications. Blue Cross and Blue Shield of Oklahoma does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.
3 Individual deductibles $2,500 and $3,500/family deductibles $5,000 & $7,000 are covered at a 80% or 100% coinsurance. Individual deductible $5,000 /family deductible $10,000 are covered at a 100% coinsurance.
4 $3,000 per calendar year, after deductible, for services received from BlueTraditional or out-of-network providers.
5 You are responsible for the entire cost of Non-Preferred Brand Drugs. However, if you use a Participating Pharmacy to fill your Prescription Order, you will be entitled to the negotiated discount applicable to all Blue Cross and Blue Shield of Oklahoma Subscribers. Please be advised that Simply Blue uses Preferred Brand Drugs on the Generics Plus Formulary. The Formulary is available online at bcbsok.com.
6 If total charges incurred equal $20,000 in one year on prescriptions, HealthCheck Basic will reimburse 100% for the rest of the calendar year.

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