Single Page Flyer  
   Video  
  
   Free    Member Cash Rewards with MemberRewards  
   Free    Medical Equipment & Supplies with ConnectDME  
   Free    Primary & Pediatric Care with MDLIVE  
   Free    Psychiatry & Counseling Care with MDLIVE  
   Free    Mental Health Support Programs with inMynd, SilverCloud, or LearnToLive  
   Free    Muscle & Joint Pain Program with Hinge Health  
   Free    Diabetes & Diabetes Prevention Programs with Omada Health  
   Free    High Blood Pressure Program with Omada Health  
   Free    High Cholesterol Program with Omada Health  
   Free    Asthma & COPD Program with Propeller  
   Free    Alcohol Addiction Program with Pelago  
   Free    Opioid Addiction Program with Pelago  
   Free    Tobacco & Vaping Addiction Program with Pelago  
   Free    Health & Wellness Program with WellOnTarget  
   Free    Weight Management Programs with Wondr Health and Omada Health  
   Free    In-Home Sleep Studies with ConnectDME  
   Free    Women's & Family Support Programs with Ovia Health  
   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    for Dependent Accident Claims  
   50%    Dependent Deductible Reimbursement  

  Making Healthy Cheaper
Silver
Health Coverage

Current & Former Employee Coverage & Rates for the 2023/24 Plan Year, effective 7/1/2023 through 6/30/2024.
   616.90    Member
   294.72    Child
   479.78    Children
   721.28    Spouse
   1,016.00    Spouse & Child
   1,201.06    Spouse & Children
Free care available from BlueDistinction+ Centers Only
   Free    Transplants
   Free    Cancer Care - Coming Soon
   Free    Cardiac Care
   Free    Spinal Care
   Free    Hip & Knee Care
   Free    Maternity Care
Resource Links
   BlueDistinction Provider Search  
   Cardiac Care Procedure Codes  
   Spinal Care Procedure Codes  
   Hip & Knee Care Procedure Codes  
   Single Page Flyer  
   Video  
  
   Free    Cash Rewards  
   Free    Medical Equipment & Supplies  
   Free    Primary & Pediatric Care  
   Free    Psychiatry & Counseling Care  
   Free    Mental Health Support Programs  
   Free    Hypertension Program  
   Free    High Cholesterol Program  
   Free    Muscle & Joint Pain Program  
   Free    Fitness & Wellness Program  
   Free    Weight-Loss Program  
   Free    In-Home Sleep Studies  
   Free    Women's & Family Support Programs  
   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    for Dependent Accident Claims  
   50%    Dependent Deductible Reimbursement  
   Carrier:    BlueCross BlueShield
   Network:    BluePreferred
   Customer Service:    800 313 5162
   Website:    www.bcbsok.com  
Personal Support When You & Your Family Need It Most
 
What is a Health Advocate?
   Provides access to you and your dependents to an all-around benefits specialist and personal health care resources
   Health Advocates are more than just customer service personnel, they are part of a dedicated support team
   The health advocate is assigned to you and your covered family members
   This way, you will have a familiar person to talk to whenever you may have a question, concern or health issue needing to be addressed
How Do You Reach a Health Advocate?
   Availability:    Monday – Friday, 7am – 7pm CST
   Phone:    800 313 5162
   Online:    www.bcbsok.com  
   Text:    BCBSOKAPP** to 33633 to download the App
   App Store:    Search for BCBSOKAPP on the Apple App Store or Google Play Store
What Can a Health Advocate Assist You With?
   Access to Programs/Services
   Medical Information
   Claims History/Status
   Benefit Details
   Claims Questions
   Health Care Support
   Navigation Guidance
   Cost Estimates for Services
   Wellness Resources
   Personal Holistic Care
   Support for Behavioral Health Issues
   Managing a Chronic Condition or Health Concern
   Specialized Clinician Support
  
Who's Part of the Health Advocate Support Team?
   Registered Nurse (RN)
   Behavioral Health Specialist
   Pharmacist
   Holistic Health Advisor
   Social Workers
   Medical Doctor
  
When Do Health Advocates Reach Out Directly to You?
   Welcome
   Health Event/Chronic Condition
   New Diagnosis
   Finding Care
   Virtual Visits Guidance
   Connectivity with Other Programs/Services
The following Out-of-Pocket costs apply to covered benefits received from BluePreferred network providers.
 
   $2,250    Deductible - Individual
   $4,500    Deductible - Family
   $7,000    Maximum Out-of-Pocket - Individual
   $14,000    Maximum Out-of-Pocket - Family
   50%    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.
 
   $4,500    Deductible - Individual
   $9,000    Deductible - Family
   $14,000    Maximum Out-of-Pocket - Individual
   $28,000    Maximum Out-of-Pocket - Family
   50%    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
 
   $500    Deductible per Individual applies to Brand Names only
   $2,500    Maximum Out-of-Pocket - Individual
   $5,000    Maximum Out-of-Pocket - Family
30-Day Supply Co-Pays
For 90-Day Supply Co-Pays, Multiply by 2.5
 
   $10 Generics   
   25% up to a maximum of $80    Preferred Brands
   40% up to a maximum of $120    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   
   20% up to a maximum of $80    Preferred Brands
   40% up to a maximum of $120    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