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Medical Plans Comparison Chart

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The Employee Assistance Program (EAP) covers five (5) visits of screening, short term counseling or referral services available per eligible employee or family member per plan year without charge, regardless of insurance plan enrollment. All requests for prior authorization for all mental health and/or substance abuse services and inquiries for EAP must be directed to BPA Health by calling (888) 559-6556 or texting (208) 336-4275.

Annual Deductible

PlanCoverage
PPO Plan In-Network$350 per person maximum, $950 per family
PPO Plan Out-Of-Network$600 per person, $1700 per family
Traditional$500 per person, $1400 per family
High Deductible Plan In-Network$2000 per person, $4000 per family

Out of Pocket Maximum

As applicable, each policy year

PlanCoverage
PPO Plan In-Network$3,250 per person maximum, $6,750 per family
PPO Plan Out-Of-Network$6,500 per person, $13,500 per family
Traditional$4,350 per person, $8,700 per family
High Deductible Plan$5,000 per person, $10,000 per family

Physician Office Visit

Plan Coverage
Traditional80% of allowable charges after deductible
PPO Plan In-NetworkPrimary Care Visit to treat an injury or illness:
  • ChoiceDocs = $0 Copay/visit

  • All other In-Network = $20 Copay/visit

  • Deductible does not apply

Specialist Visit:
  • ChoiceDocs = $20 Copay/visit

  • All other In-Network = $40 Copay/visit

  • Deductible does not apply
PPO Plan Out-Of-Network 70% of allowable charges after deductible
High Deductible Plan 70% of allowable charges after deductible

Hospital Services Emergency Ambulance Transportation Outpatient Surgery

PlanCoverage
Traditional80% of allowable charges after deductible
PPO Plan In-Network85% of allowable charges after deductible
PPO Plan Out-Of-Network70% of allowable charges after deductible
High Deductible Plan70% of allowable charges after deductible

Outpatient Psychotherapy Services

Plan,Coverage
Traditional80% of allowable charges after deductible
PPO Plan In-Network,$20 copayment per visit
PPO Plan Out-Of-Network,70% of allowable charges after deductible
High Deductible Plan,70% of allowable charges after deductible

Psychiatric Outpatient Facility, Inpatient and Other Professional Services

PlanCoverage
Traditional80% of allowable charges after deductible
PPO Plan In-Network85% of allowable charges after deductible
PPO Plan Out-Of-Network70% of allowable charges after deductible
High Deductible Plan70% of allowable charges after deductible

Outpatient Rehabilitation Therapy Services

PlanCoverage
Traditional80% of allowable charges after deductible. Occupational and speech therapies are limited to 20 visits annual max.

Physical therapy - 40 visits annual max.
PPO Plan In-Network85% of allowable charges after deductible. Occupational and speech therapies are limited to 20 visits annual max.

Physical therapy - 40 visits annual max.
PPO Plan Out-Of-Network70% of allowable charges after deductible. Occupational and speech therapies are limited to 20 visits annual max.

Physical therapy - 40 visits annual max.
High Deductible Plan70% of allowable charges after deductible. Occupational and speech therapies are limited to 20 visits annual max.

Physical therapy - 40 visits annual max.

Wellness/Preventive Services

Traditional, PPO Plan In-Network, and High Deductible Plans

  • All Affordable Care Act (ACC) listed preventative services will be covered 100% when in-network. No annual limits
  • Services not specifically listed are subject to deductible and coinsurance.

PPO Out-Of-Network Plan

  • 70% of allowable charges after deductible.

Telehealth/MDLive

PlanCoverage
Traditional80%
PPO Plan In-Network$10 co-pay
PPO Plan Out-Of-NetworkNA
High Deductible Plan70%

Prescription Drugs

1st Tier – Generic

$10 co-pay for all plans

2nd Tier – Preferred Brand

$30 co-pay for all plans

3rd Tier – Non-Preferred Brand

$60 co-pay for all plans

4th Tier – Specialty Drugs

Plan,Coverage
Traditional,$100 co-pay Out-of-Pocket Maximum on Prescription Drugs: $2-000 per person / $4,000 per family
PPO Plan In-Network,$100 co-pay Out-of-Pocket Maximum on Prescription Drugs: $2,000 per person / $4,000 per family
PPO Plan Out-Of-Network,$100 co-pay
High Deductible Plan,$100 co-pay, Other than preventative, all pharmacy and medical services are subject to the deductible before any benefits are paid. High Deductible pharmacy benefit has a 30% copay after deductible.
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