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Medical Plan

Blue Cross Blue Shield offers two designs that consist of traditional Preferred Provider Organization (PPO) plans.

The rates below let you know how much money the City is paying each month for your health coverage, regardless of which health plan you choose.

Core Plan
	Monthly Premium	City Monthly Contribution ($)	Employee Monthly Contribution ($)
Employee Only	$393.43	$393.43	$0.00
Employee + Spouse	$854.90	$508.48	$346.42
Employee + Child(ren)	$820.40	$493.98	$326.42
Employee + Family	$1269.31	$892.89	$376.42

Buy-Up Plan
	Monthly Premium	City Monthly Contribution ($)	Employee Monthly Contribution ($)
Employee Only	$438.22	$386.26	$51.96
Employee + Spouse	$961.99	$441.17	$520.82
Employee + Child(ren)	$923.17	$422.35	$500.82
Employee + Family	$1428.31	$897.49	$530.82

Benefit Summary Comparison-PPO
	Blue Cross Blue Shield Core Plan		Blue Cross Blue Shield Buy-Up Plan
	In Network	Out of Network	In Network	Out of Network
Deductible (calendar year) Individual Family	$1,500 $3,000	$3,000 $6,000	$500 $1,000	$1,000 $2,000
Physician Services Office visits Specialist office visit Prenatal care Allergy injections Impatient/Outpatient services Allergy/Serum		60% after deductible		60% after deductible
	$30		$30
	$30		$30
	$30		$30
	$30		$30
	80% after deductible		80% after deductible
	80% after deductible		80% after deductible
Preventative Care Annual Routine physical exam/child care Routine Mammography Routine lab and x-ray	100% after copay 100% after copay 100% after copay	60% after deductible	100% after copay 100% after copay	70% after deductible
Hospital Services Inpatient care Outpatient surgery Outpatient nonsurgical care (including diagnostic and X-ray) Emergency room
	80% after deductible	60% after deductible	80% after deductible	70% after deductible
	80% after deductible	60% after deductible	80% after deductible
	80% after deductible	60% after deductible	80% after deductible	70% after deductible
	80% after $100 copay	60% after deductible	80% after $100 copay	80% after $100 copay
Other Medical Services Urgent Care	$50 copay	60% after deductible	$35 copay	60% after deductible
Maximum Out-of-Pocket Individual Family	$5,000 $10,000	$10,000 $20,000	$2,500 $5,000	$5,000 $10,000
Lifetime Max	Unlimited	$1,000,000	Unlimited	$1,000,000
Drug Plan Generic Brand Non-formulary	$10 $30 $60	60% after deductible	$8 $25 $50	60% after deductible

	The City of DeSoto, Texas 211 East Pleasant Run Road DeSoto, TX 75115 Ph: 972.274.CITY (2489)	Home News & Events Calendar	Contact Us Document Center Employees Only	Interactive Map Site Map Financial Reports	Newsletter Accessibility Powered by CivicPlus

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