Population: New or Prospective Non-Represented
What's Right for Me?
This section has tools to help you get the most our of your health benefits. Use these tools to compare the health and dental options so that you can decide what’s best for you and your family. These tools also help you estimate how much to put in a Health Care reimbursement account, and project the health benefits you will receive after you retire.
Compare Medical and Dental Options
The following chart gives you a quick overview of the Medical Plan and Dental Plan Options available to you. Use this to determine the best plan for you and your family’s needs.
| Coverage Option |
Premium vs.
Out-of-Pocket Costs |
Simple Pros and Cons |
| Medical Benefits
Program |
| Deductible Options |
The higher the deductible level,
the lower the premium—ranging from least to most
expensive options |
Pros
- Cost protection of an annual out-of-pocket limit
- Access to the Preferred Provider
Organization (PPO) to reduce costs
- You can visit any provider
- There's no cap on reimbursement of eligible expenses
Cons
- Not practical if you expect to receive extensive medical care
- You must fill out claim forms
- You'll pay for most preventive care
|
| Point-of-Service (POS) Option—Residing In New Jersey |
- Mid-priced premium
- Most in-network care requires a copayment
- Most out-of-network care requires 30% coinsurance up to an out-of-pocket maximum
|
Pros
- You can choose a Primary Care Physician (PCP) to manage your general and preventive care and refer you to network specialists when necessary
- You do not have to visit a network provider; out-of-network services are covered
- No claim forms are necessary when you use network providers
- Practical if you expect to receive extensive medical care and are comfortable using network providers
Cons
- Out-of-network care is more expensive
|
| Point-of-Service (POS) Option—Residing Outside of New Jersey |
- Mid-priced premium
- Most in-network care requires a copayment
- Most out-of-network care is not covered
|
Pros
- Do not need to select a Primary Care Physician (PCP) or obtain referrals to receive the in-network level of benefits
- Have low out-of-pocket costs when you receive care from a BlueCard PPO provider
- Receive full coverage for in-network preventive care services, such as well-child care and routine physicals, after a copayment
Cons
- Higher out-of-pocket costs if you go outside the network for care
|
| Exclusive Provider Organization (EPO) Option |
- Mid-priced premium
- Most in-network care requires a copayment
- Coinsurance is required for care received outside the EPO network
|
Pros
- Do not need to select a Primary Care Physician (PCP) or obtain referrals to receive the in-network level of benefits
- Have low out-of-pocket costs when you receive care from the EPO network
- Receive full coverage for in-network preventive care services, such as well-child care and routine physicals, after a copayment
Cons
-
Out-of-network care is not covered unless it is an emergency
|
| Health Maintenance Organization
(HMO) Options |
- Mid-priced premiums
- Most in-network care requires a copayment
- Generally, out-of-network care is not covered
|
Pros
- Most predictable and lowest out-of-pocket costs
- You choose a Primary Care Physician (PCP) to manage
your general and preventive care and refer you to
network specialists when necessary
- No claim forms are necessary
Cons
- Out-of-network care is not
covered unless it is an emergency
|
| Coverage Option |
Premium vs.
Out-of-Pocket Costs |
Simple Pros and Cons |
| Dental Benefits
Program |
| Dental/Vision Option |
- Most expensive dental option
- No out-of-pocket cost for first $250 of expenses; 20% coinsurance for next $1,500 of expenses
|
Pros
- Vision expenses are eligible for reimbursement
- You can visit any provider
- Access to the Preferred Provider Organization (PPO) to reduce costs
- Practical if you expect to receive up to $1,750
worth of care
Cons
- Vision coverage is limited to $300 per year, for
you and your family members combined
- You must fill out claim forms
|
| Dental Freedom of Choice (FOC) Option |
- Mid-priced option
- Most in-network care requires between 20% and 40% coinsurance
- Most out-of-network care requires 50% coinsurance
|
Pros
- Diagnostic and preventive care is covered at 100%
(in- and out-of-network)
- You can visit any provider under
the out-of-network level
- Must visit a network provider
under in-network level
- Access to the Preferred Provider
Organization (PPO) to reduce costs (out-of-network
care)
- No deductibles to meet before benefits are paid
Cons
- Not practical if you expect to receive extensive
dental care
- Out-of-network maximum reimbursement of $750 per
participant, per year
|
| Dental Maintenance Organization (DMO) Option |
- Lowest-priced option
- Coinsurance between 40% and 50% required for some coverage
|
Pros
- You can choose a participating dentist to manage your general and preventive care and refer you to network specialists when necessary
- Coverage for diagnostic and preventive care and oral surgery, periodontics, and endodontics is covered at 100%
- No deductible required
- You do not have to fill out claim forms
Cons
- Out-of-network care is not covered
|
