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Retiree Medical & Prescription Drug

BCI logo The State offers three medical plan options so that retirees can select the plan that best meets their needs as well as access providers in their geographic area. Each medical plan provides comprehensive coverage, with different levels of out-of-pocket expenses and premium contribution rates.  Prescription Drug Coverage is included with medical plan enrollment. Retiree plans do not include Vision or EAP benefits or dental coverage. Deductibles and benefits for all plans are provided on a fiscal year, from July 1 through June 30.


PPO Highlights:
  • You save money when you use In-Network Blue Cross of Idaho providers
  • Most retirees choose this plan
Traditional Highlights:
  • Not limited to network providers
  • Includes more provider options, particularly in rural, out-of-network areas
High Deductible Highlights:
  • Now HSA compatible; therefore, all services and prescriptions that are not preventive in nature are subject to the deductible before the plan begins to pay.

Retiree Medical Plan Comparison & Plan Contract

Feature NamePPO In-NetworkPPO Out-of-NetworkTraditionalHigh Deductible
FY21 Plan ContractsRetire PPO - UpdatedRetire PPO - UpdatedRetiree Trad - UpdatedRetiree HDHP - Updated
FY21 Plan SummaryRetiree PPO SBCRetiree PPO SBC Retiree Traditional SBCRetiree HDHP SBC
Deductible - Individual$350$600$450$2,000
Deductible - Family$950$1,700$1,250$6,000
Out-of-Pocket Limit - Individual$3,250$6,500$4,300$5,000
Out-of-Pocket Limit - Family$6,750$13,500$8,600$10,000
Plan Payment (% of allowable charges after deductible)$20 copay / 85%70%80%70%
Wellness/Preventive CareNo-copay for listed services70%100%100%
For details about premiums, please see Retiree Premium Rates.
Please keep in mind that deductibles and benefit payments are based on allowable charges. Details about the medical plans, exclusions and waiting periods, can be found in each medical plan document and Summary of Benefits & Coverage (SBC).

Prescription Drug Prescription Drug Coverage

Prescription Drug Formulary

TierCopay
Tier 1 - Generic$10
Tier 2 - Preferred Brand$30
Tier 3 - Non-preferred Brand$60
Tier 4 - Specialty$100
Mail Order Prescriptions90 days for 2 copays

lightning bolt icon ATTENTION HDHP MEMBERS: The costs for all prescriptions not listed on the HDHP Preventive List are subject to the HDHP deductible. Benefits will not begin until the deductible is met on the HDHP plan.

For a covered Prescription Drug dispensed by a Physician or a Licensed Pharmacist who is not a Participating Pharmacist, the Insured is responsible for paying for the Prescription Drug at the time of purchase and must submit a claim to BCI or one (1) of its designated claims processing vendors. The amount of payment for a covered Prescription Drug is the balance remaining after subtracting the Prescription Drug Copayment and/or Coinsurance from the lower of the Allowed Charge or the Usual Charge for the Prescription Drug.

 

 

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