MAGNOLIA OPEN ACCESS
The Magnolia Open Access Plan offers coverage both inside and outside of the Blue Cross nationwide network.
Though the premiums for the Magnolia Open Access plan are higher than OGB’s other plans, its moderate deductibles combined with a nationwide network make it an attractive plan for members who live out of state or travel regularly.
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MEDICAL COVERAGE
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Single
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Employee
+ Spouse
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Employee
+ Children
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Family
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Deductible – Active Employee/Non-Medicare Retiree (on or after 3/1/2015)
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$900
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$1,800
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$2,700
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$2,700
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Deductible Retiree (with or without Medicare before 3/1/2015)
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$300
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$600
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$900
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$900
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Coinsurance – Active Employee/Non-Medicare Retiree (In-Network)
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10%
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10%
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10%
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10%
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Coinsurance – Medicare Retiree (In-Network)
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20%
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20%
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20%
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20%
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Active Employee/Non-Medicare Retiree (Out-of-Network)
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30%
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30%
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30%
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30%
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Out-of-Pocket Maximum – Active Employee/Non-Medicare Retiree On or After 3/1/15
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$3,500
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$6,000
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$8,500
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$8,500
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Out-of-Pocket Maximum – Non-Medicare Retiree (In-Network Before 3/1/15)
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$2,300 individual; plus $1,300 per additional
person up to 2; plus $1,000 per additional
person up to 10 people; $12,700 for a family of 12+
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Out-of-Pocket Maximum – Medicare Retiree (Out-of-Network Before 3/1/15)
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$3,300 individual; plus $2,300 per additional person up to 2; plus $2,000 per additional person up to 2 additional people; $12,700 for a family of 5+
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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 name drug, or specialty drug.
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Tier
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Member Co-Pay
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Generic
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50% up to $30
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Preferred
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50% up to $55
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Non-Preferred
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65% up to $80
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Specialty
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50% up to $80
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Once you pay $1,500:
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Generic
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$0
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Preferred
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$20
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Non-Preferred
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$40
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Specialty
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$40
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*Member responsibility is for a prescription drug benefit of up to a 31-day supply.
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Blue Cross and Blue Shield of LA
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www.bcbsla.com/ogb
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1-800-392-4089
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8:00 AM – 5:00 PM CT Monday-Friday
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CVS Caremark
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www.caremark.com
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1-877-300-1906
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24 Hours, Seven Days a Week
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SilverScript
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www.caremark.com
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1-888-996-0104
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24 Hours a day
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Seven Days a Week
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