Blue Cross - Pelican HRA
Southeastern will contribute $1,000 to the HRA for employee only coverage, and $2,000 for all other levels of coverage. This employer funded contribution to your HRA can help offset the deductible you a responsible for. The HRA Plan has a $2,000 deductible for employee only and $4,000 deductible for all other levels of coverage. After deductible is met, the member pays 20% of contracted rate. The maximum out-of-pocket expense in-network is $5000 for employee only and $10,000 for all other levels of coverage, including deductibles. Effective July 1, 2011 there is an unlimited lifetime medical maximum. Note: Individual plan documents should be consulted for more details. More information, including a list of Blue Cross providers is available on Group Benefits website: groupbenefits.org or https://www.bcbsla.com/ogb
The prescription benefits for these plans are administered by Med Impact. The member pays 50%; maximum $50 per 30-day fill; and after $1500 per person per plan year, the co-pay is $0 for generic $15 for brand. NOTE: The pharmacy benefits are mandatory generics. Plan member who chooses brand name drug for which approved generic version is available pays cost difference between brand name drug and generic drug, plus 50% co-pay amount for brand name drug; cost difference does not apply to $1500 out-of-pocket maximum. You can contact MedImpact at 800-910-1831.