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https://aptia365.com/horacemann 8 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.Review Your Medical Plan OptionsBlue Cross Blue Shield of ILNetwork: Bluecard PPOBenefits are per insured person and after deductible.$2,000 Deductible $3,300 Deductible $4,500 DeductibleHealth Savings AccountHSA Eligible Yes Yes YesHSA Employer Funding$500/year individual $1,000/year family$500/year individual $1,000/year family$500/year individual $1,000/year familyIn-Network Out-Of-Network In-Network Out-Of-Network In-Network Out-Of-NetworkAnnual DeductibleIndividual $2,000 $4,000 $3,300 $6,600 $4,500 $9,000Family $4,000 $8,000 $6,600 $13,200 $9,000 $18,000Out-of-Pocket MaximumIndividual $4,000 $8,000 $6,000 $12,000 $6,550 $13,100Family $8,000 $16,000 $12,000 $24,000 $13,100 $26,200Medical Benefits CoveragePlan Coinsurance 80% 60% 70% 50% 70% 50%Preventive Care 100%* 60% 100% 50% 100% 50%Primary/Specialist Visit 80% 60% 70% 50% 70% 50%Urgent Care 80% 60% 70% 50% 70% 50%Inpatient Hospital 80% 60% 70% 50% 70% 50%Outpatient Hospital 80% 60% 70% 50% 70% 50%Emergency Room 80% 80% 70% 70% 70% 70%Retail Prescriptions(30-day supply)Generic 80%** 80%** 70%** 70%** 70%** 70%**Preferred Brand 80%** 80%** 70%** 70%** 70%** 70%**Non-Preferred 80%** 80%** 70%** 70%** 70%** 70%**Mail-order Prescriptions(90-day supply)Generic 80%** Not covered 70%** Not covered 70%** Not coveredPreferred Brand 80%** Not covered 70%** Not covered 70%** Not coveredNon-Preferred 80%** Not covered 70%** Not covered 70%** Not covered*Deductible does not apply.**Deductible waived for some medications.Medical and Prescription Drug Coverage