Benefit Plan Summaries

 

ACA SUMMARIES OF BENEFITS & COVERAGE (SBC) / BENEFITS AT A GLANCE (BAAG)


 

Blue Cross Community Blue PPO Plans:

EMPLOYEE / RETIREE GROUPS SBC BAAG
Active Employees of Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
Pre-Medicare Retirees of Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
Medicare-Eligible Retirees of POAM, Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA Not Required Click Here

Blue Cross Simply Blue High Deductible Health Plans (HDHP) PPO:

EMPLOYEE / RETIREE GROUP SBC BAAG
Active Employee of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
All Other Benefit-Eligible Active Employees Click Here Click Here
Pre-Medicare Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
Medicare-Eligible Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Not Required Click Here
All Other Pre-Medicare-Eligible Retirees (EXCLUDES retirees eligible under Retiree Stipend Program) Click Here Click Here
All Other Medicare-Eligible Retirees (EXCLUDES retirees eligible under Retiree Stipend Program) Not Required Click Here

Blue Care Network (BCN) Full Provider Network HMO Plans:

EMPLOYEE / RETIREE GROUP SBC BAAG
Active Employees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
All Other Benefit-Eligible Active Employees Click Here Click Here
Pre-Medicare Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Click Here Click Here
Medicare-Eligible Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Not Required Click Here
All Other Pre-Medicare Benefit-Eligible Retirees (EXCLUDES retirees eligible under Retiree Stipend Program) Click Here Click Here
All Other Medicare-Eligible Retirees (EXCLUDES retirees eligible under Retiree Stipend Program) Not Required Click Here

Blue Care Network (BCN) PCP Focus HMO Plans:

EMPLOYEE / RETIREE GROUP SBC BAAG
All Active Employees EXCLUDING Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA Employees Click Here Click Here
Pre-Medicare Benefit-Eligible Retirees EXCLUDING Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA and retirees eligible under Retiree Stipend Program) Click Here Click Here
Medicare-Eligible Retirees EXCLUDING Retirees of Legislative Branch Exempt (INCLUDING Elected Officials & Judges), 3rd Circuit GAA, JAA and retirees eligible under Retiree Stipend Program Not Required Click Here

ACA Minimum Value Plan- Blue Cross Simply Blue HDHP

EMPLOYEE GROUP SBC BAAG
Plan for Employees Working 30 or More Hours Per Week on Average Click Here Click Here

Delta Dental Plans:

PLAN DESCRIPTION BAAG / FEE SCHEDULE
Delta Dental PPO Standard Plan (Active Employees Only) Click Here
Delta Dental EPO Plan (Active Employees Only) Click Here
   

Golden Dental Plans:

PLAN DESCRIPTION BAAG / FEE SCHEDULE
Golden Dental Radiant DHMO Plan (Active Employees Only) Click Here
Golden Dental Smile Guard DHMO Plan (Active Employees Only) Click Here
Golden Dental DHMO Voluntary Retiree Dental Plan Click Here

Heritage Vision Plans:

PLAN DESCRIPTION BAAG
Heritage Vision Plan (Active Employees Only) Click Here

Heritage Vision Plan Supplemental Retiree Vision Plan

This plan does NOT replace retiree Optical Reimbursement benefit. For information regarding Optical Reimbursement benefits click here.

Click Here

 

Director of Management & Budget
(313) 224-0420

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