Diamond Choice Health Coverage Title Image

Click to expand each section
Current & Former Employee Coverage & Rates for the 2025/26 Plan Year, effective 7/1/2025 through 6/30/2026.
   776.70    Member
   371.06    Child
   604.08    Children
   908.12    Spouse
   1,279.18    Spouse & Child
   1,512.20    Spouse & Children
Covered Individuals Pay Zero Out-of-Pocket for:
   Transplants
   Cancer Care
   Cardiac Surgeries
   Spine Surgeries
   Hip & Knee Replacements
   Maternity Care
   Cellular Immunotherapy
Free Major Medical Coverage is Available from BlueDisctinction+ Providers Only, No Out-of-Network Coverage Exists, Except for Cancer & Maternity Care.
Resource Links
      BlueDistinction+ Provider Search  
      Heart & Cardiac Surgery Procedure Codes  
      Back & Spine Surgery Procedure Codes  
      Hip & Knee Replacement Procedure Codes  
   Single Page Flyer  
   Video  
  
      Free    Member Rewards with Zelis  
      Free    Virtual Check-Ups with Catapult Health  
      Free    Primary & Pediatric Care with MDLIVE  
      Free    Psychiatry & Counseling Care with MDLIVE  
      Free    Medical Equipment & Supplies with Connect DME  
      Free    MRI, CT & PET Scans with Green Imaging  
      Free    X-Rays & Ultrasounds with Green Imaging  
      Free    Diabetes & Diabetes Prevention Programs with Omada  
      Free    High Blood Pressure Program with Omada  
      Free    High Cholesterol Program with Omada  
      Free    Muscle & Joint Pain Programs with Hinge Health  
      Free    Pelvic Floor Pain Program with Hinge Health  
      Free    Alcohol Addiction Program with Pelago  
      Free    Opioid Addiction Program with Pelago  
      Free    Tobacco & Vaping Addiction Program with Pelago  
      Free    Mental Health Support Program with Inmynd  
      Free    Mental Health Support Program with SilverCloud  
      Free    Mental Health Support Program with LearnToLive  
      Free    Women's & Family Support Programs with Ovia  
      Free    Wellness Programs with Well onTarget  
      Free    Weight-Loss Programs with Wondr Health and Omada  
      Free    In-Home Sleep Studies with Connect DME  
      Free    OTC Acid-Reflux & GERD Medications
      $5    OTC Antihistamine Medications
      Free    Tobacco & Smoking Cessation Medications
      $25    Insulin - Preferred Brands
      $5    Diabetic Oral Generic Medications
      $500    Child Accident Reimbursement  
      50%    Child Deductible Reimbursement  
   Carrier:    BlueCross BlueShield
   Network:    BlueChoice
   Customer Service:    800 672 2567
   Website:    www.bcbsok.com  
The following Out-of-Pocket costs apply to covered benefits received from BlueChoice network providers.
 
   $1,000    Deductible - Individual
   $2,000    Deductible - Family
   $5,000    Maximum Out-of-Pocket - Individual
   $10,000    Maximum Out-of-Pocket - Family
   20%    Co-Insurance
   Preventive Services  
Office Visit Co-Pays only apply to the Office Visit charge.
Additional charges received during an Office Visit are subject to Deductible & Co-Insurance.
 
   Free    Virtual Primary & Pediatric Care - MDLIVE  
   $25    In-Person Primary & Pediatric Care Co-Pay
   Free    Virtual Counseling & Psychiatry - MDLIVE  
   Free    Virtual Urgent Care - MDLIVE  
   $25    In-Person Urgent Care Co-Pay
   $50    In-Person Specialist Care Co-Pay
   $50    Emergency Room Co-Pay (Waived if Admitted)
The following Out-of-Pocket costs apply to covered benefits received from Out-of-Network providers.
Amounts paid towards Out-of-Network Deductible and Maximum Out-of-Pocket do not count towards In-Network amounts and vice versa.
 
   $2,000    Deductible - Individual
   $4,000    Deductible - Family
   $10,000    Maximum Out-of-Pocket - Individual
   $20,000    Maximum Out-of-Pocket - Family
   30%    Co-Insurance of Allowable Cost
   100%    Balance Billing for Amounts Over Allowable Cost
   $1,000    In-Patient Pre-Authorization Penalty Deductible
         Per admission when using an Out-of-Network Provider and Pre-Authorization is not obtained, as required.
         Waived if admission is Pre-Authorized by the Claims Administrator.
         Does not apply towards the Maximum Out-of-Pocket.
   Carrier:    Express Scripts (ESI)
   Network:    National Preferred Formulary
   Rx Formulary Search Tool  
   Rx Formulary  
   Rx Exclusions  
   Customer Service:    855 315 2460
   Specialty Pharmacy:    800 803 2523
   Website:    http://www.express-scripts.com  
The following Out-of-Pocket costs apply to prescription medications received from In-Network pharmacies
 
   $75    Deductible per Individual applies to Brand Names only
   $2,000    Maximum Out-of-Pocket - Individual
   $4,000    Maximum Out-of-Pocket - Family
30-Day Supply Co-Pays
For 90-Day Supply Co-Pays, Multiply by 2.5
 
   $10    Generics
   $45    Preferred Brands
   $60    Non-Preferred Brands
 
Co-Pay Assistance
Some covered medications may have a manufacturers co-pay Patient Assistance Program available to help reduce the co-pay amount. Use the followng link to view a list of these medications.
           Co-Pay Patient Assistance Program Drugs  
 
Rx Resources
  Rx Formulary Search Tool  
  Rx Formulary  
  Rx Exclusions  
30-Day Supply Co-Pays
 
   $10    Generics
   $60    Preferred Brands
   $100    Non-Preferred Brands
 
Specialty Co-Pay Assistance
Some covered specialty medications may have a manufacturers co-pay Patient Assistance Program available through the OPEH&W's partner SaveOn, to help reduce the co-pay amount. Use the followng link to view a list of these medications.
           SaveOn Specialty Co-Pay Patient Assistance Program Drugs  
 
Rx Resources
  Rx Formulary Search Tool  
  Rx Formulary  
  Rx Exclusions  
30-Day Supply
   Free    Contraceptives & Contraceptive Devices
   Free    Tobacco Quitting Solutions
   Free    GERD & Acid Reflux Over-The-Counter (OTC) Medications
         Includes: Nexium, Prevacid, Prilosec, Protonix, Omeprazole & Zegerid
   $5    Antihistamine Over-The-Counter (OTC) Medications
         Includes: Alavert, Claritin, Flonase, Mucinex, Nasacort, Nasonex & Zyrtec
   $5    Diabetic Generic Oral Medications
   $25    Insulin - Select Brands Only