MAGNOLIA LOCAL PLUS

The Magnolia Local Plus plan offers the same coverage as the Magnolia Local plan. This plan offers $25 primary care co-pays and $50 specialty care co-pays.

The Local Plus plan is ideal for members who prefer the predictability of co-payments rather than using employer funding to offset out-of-pocket costs.

This plan provides care in the Blue Cross nationwide network. Out-of-network care is provided in emergencies only.

MEDICAL COVERAGE
 

Single

Employee
+ Spouse

Employee
+ Children

Family

Deductible – Active Employee/Non-Medicare Retiree (on or after 3/1/2015)

$400

$800

$1,200

$1,200

Deductible Retiree (with or without Medicare before 3/1/15)

$0

$0

$0

$0

Co-pay(In-Network)

$25/$50

$25/$50

$25/$50

$25/$50

Out-of-Pocket Maximum – Active Employee/Non-Medicare Retiree (on or after 3/1/15)

$3,500

$6,000

$8,500

$8,500

Out-of-Pocket Maximum – Retiree (with or without Medicare before 3/1/15)

$2,000

$3,000

$4,000

$4,000
 

PHARMACY BENEFITS – CVS Caremark

OGB uses the CVS Caremark formulary to help members select the most appropriate, lowest-cost options. The formulary is reviewed regularly to reassess drug tiers based on the current prescription drug market. Members will continue to pay a portion of the cost of their prescriptions in the form of a co-pay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred brand, non-preferred brand or specialty drug.

Tier

Member Co-Pay

Generic

50% up to $30

Preferred

50% up to $55

Non-Preferred

65% up to $80

Specialty

50% up to $80

Once you pay $1,500:

Generic

$0

Preferred

$20

Non-Preferred

$40

Specialty

$40

*Member responsibility is for a prescription drug benefit of up to a 31-day supply.