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The SEG Choice plan is a consumer-driven health plan featuring affordable premiums. In this plan, medical and prescription costs combine to satisfy the deductible and out-of-pocket maximum.

The medical plan provides:

  • 100% coverage of preventive care, regardless of deductible. View the complete approved list .
  • 80% coverage for all medically necessary services received from in-network providers after deductibles have been satisfied, including office visits, inpatient care, outpatient care, labs, and therapies.
  • Prescription benefits.
  • The BlueCross network of providers, which can save you money and protect your from unnecessary costs.
  • The option to establish a health savings account (HSA), if you are eligible, through HSA Bank to help you manage your health care dollars.

Understanding Deductibles & Out-of-Pocket Maximums

  • Preventive care is covered 100%, regardless of deductible.
  • The deductible ($1,500/individual; $3,000/family) must be met before SEG pays any portion of non-preventive care claims.
  • One member of the family can meet the entire family deductible.
  • Prescription benefits are not paid by SEG until the Choice plan deductible is met, with the exception of certain preventive generic drugs through the SEG Pharmacy.
  • Both medical and prescription claims count toward the deductible and the out-of-pocket maximum. Vision and dental expenses do not contribute to the deductible or out-of-pocket maximum.

Common Questions

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SEG focuses on helping to keep you well, rather than just providing benefits for illness or injury. Your plan includes 100% coverage for preventive care which includes periodic wellness exams, certain cancer screening, and immunizations for women, men and children. Several respected organizations establish what is included in the preventive standard of care. They include the United States Preventive Services Task Force (USPSTF), the American Academy of Pediatrics, American Academy of Family Medicine and others. Your doctor will determine the tests that are right for you based on your age, gender and family history.
If the doctor does not perform his/her own lab work or radiology in office then it will be billed to BCBSSC independently from a separate facility. If the lab work or x-ray is in conjunction with a preventive screening and it has been coded with the appropriate preventive procedure and diagnosis codes, the claim should process accurately. If not, you’ll need to contact BCBSSC Customer Service and they will adjust the claim as necessary.
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Your deductible is the amount of money you pay out-of-pocket for your health care before SEG starts sharing the cost of care with you. If you use in-network providers, you pay 100% of the contracted allowed amount to the provider and 100% of the cost of prescriptions until you reach the deductible amount (with the exception of preventive care and preventive generic medication at the SEG Pharmacy where the plan always pays 100% even before you meet the deductible).

Both medical and pharmacy claims count toward the deductible in the Choice Plan. Both medical and prescription claims count toward Choice plan out-of-pocket max. Prescription benefits are not paid by SEG until the Choice plan deductible is met, with the exception of certain preventive generic drugs through the SEG pharmacy.

Not all Urgent Care facilities will provide primary care; however Doctor’s Care offices can serve as both an Urgent Care Provider and Primary Care Physician. Services are coded and you are charged based on your benefit plan and type of service you receive. For example, if you go in on Saturday because you cut your finger doing yard work and need to have stitches, it will be coded as urgent care. If you go in on Monday to have the doctor check your sore throat, it will be coded as primary care. Always check with your local urgent care provider to make sure they are 1) in network, and 2) provide routine, non-urgent, care.
A stress test is not typically part of a routine screening. In most cases it is for further evaluation of a suspected problem which would exclude it from the preventive benefit.
Specialists are all physicians other than Family Practice, General Medicine, Internal Medicine, Pediatrics, and OB/GYN.
If you make a change in plan coverage you will receive a new medical card in 2016. Note that all ID cards will have the name of the employee (subscriber) on them.
BCBSSC automatically restricts subscriber access to any diagnosis or procedure code information if the dependent is age 16 or over.

On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (PPACA), into law. The new law, and changes made to the law by subsequent legislation, focuses on provisions to expand coverage, control health care costs, and improve health care delivery system.

SEG is committed to following all mandates required by the new law and will inform our employees of changes that will apply to them. If you interested in learning more about the new law, visit the BlueCross website for more information on health care reform and how it impacts you.

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