Historical Overview
| Plan Year |
|
OPEH&W % |
|
National % |
| 2024-25 |
|
5.0^ |
|
9.0 |
| 2023-24 |
|
5.0 |
|
12.0 |
| 2022-23 |
|
9.5 |
|
22.5 |
| 2021-22 |
|
2.0* |
|
5.7 |
| 2020-21 |
|
3.0 |
|
7.9 |
| 2019-20 |
|
4.0 |
|
6.9 |
| 2018-19 |
|
2.5 |
|
7.5 |
| 2017-18 |
|
7.4 |
|
8.0 |
| 2016-17 |
|
7.5 |
|
7.8 |
| 2015-16 |
|
0.0 |
|
3.9 |
| 2014-15 |
|
1.2* |
|
5.3 |
| 2013-14 |
|
0.0 |
|
4.1 |
| 2012-13 |
|
5.0 |
|
6.1 |
| 2011-12 |
|
8.5 |
|
8.5 |
| 2010-11 |
|
6.0 |
|
6.9 |
| 2009-10 |
|
5.0 |
|
6.3 |
| 2008-09 |
|
5.0 |
|
6.0 |
* Increase applies only to Employee tier, Spouse and Child tiers unchanged.
^ Increase for Diamond, other health plan design increase were less.
Historical Detail
2024-25 Plan Year
5.0% Rate Increase
Increase for Diamond, other health plan design increase were less.
9.0% National Trend
Benefit Changes
Require Blue Distinction Centers for Major Medical Surgeries, applies to:
Transplants
Hip & Knee Surgeries
Cardiac Surgeries
Spinal Surgeries
Only Applies to Scheduled Surgeries.
Does Not Apply to Emergencies.
No Out-of-Network Coverage Available.
Allow Bariatric Surgeries
Only for Members and Spouses.
No Coverage for Dependent Children.
Individual
Must Be Enrolled for Health Coverage
through Employer for
2 Consecutive Years.
Only available at BlueDistinction & BlueDistinction+ Providers.
Currently in Oklahoma, these are Bailey, Integris & Norman.
Only for Lap Bands & Gastric Sleeves
under the following procedure codes:
Gastric Sleeve: 43775
Lap Band: 43770, 43771, 43772, 43773,
43774, 43886, 43887, 43888 & S2083
Eligibility Subject to Blue Cross’s Medical Policy
Criteria SUR 716.003 & SUR 716.006.
http://tinyurl.com/39fr8nzy
Coverage Subject to Deductible & Co-Insurance.
Changes to Platinum Health Plan Option Design
Changed In-Network Individual Deductible to $
1,500
Changed In-Network Family Max Deductible to $
3,000
Changed In-Network Individual Max Out-of-Pocket to $
5,000
Changed In-Network Family Max Out-of-Pocket to $
10,000
Changed Out-of-Network Individual Deductible to $
30,000
Changed Out-of-Network Family Max Deductible to $
6,000
Changed Out-of-Network Individual Max Out-of-Pocket to $
10,000
Changed Out-of-Network Family Max Out-of-Pocket to $
20,000
Change Pharmacy Preferred Brands Co-Pay to $
55
Change Pharmacy Non-Preferred Brands Co-Pay to $
70
2023-24 Plan Year
5.0% Rate Increase
12.0% National Trend
Benefit Changes
Added Coverage for Implants as a Major service to both the Standard & Enhanced coverage options
Added Pelago - Tobacco, Vaping, Alcohol & Opioid Addiction Program
Added Propeller - Asthma & COPD Program
2022-23 Plan Year
9.5% on Diamond
22.5% National Trend
Benefit Changes
Added Essential Medical Eye Care to Vision Coverage
| |
Diamond |
|
Platinum |
|
Gold |
|
Silver |
|
Bronze |
| Medical Deductible Increased to |
1,000 |
|
1,750 |
|
3,250 |
|
2,250 |
|
4,250 |
| Medical Max Out-of-Pocket Increased to |
5,000 |
|
6,000 |
|
7,000 |
|
7,000 |
|
7,500 |
| Urgent Care Co-Pay Increased to |
25 |
|
25 |
|
25 |
|
25 |
|
25 |
| Primary Care Co-Pay Increased to |
25 |
|
25 |
|
25 |
|
25 |
|
25 |
| Rx Deductible Increased to |
75 |
|
No Change |
|
No Change |
|
No Change |
|
No Change |
| Rx Max Out-of-Pocket Increased to |
2,500 |
|
2,500 |
|
2,500 |
|
No Change |
|
No Change |
2021-22 Plan Year
2.0% OPEH&W Rate Increase - Employee Tier Only
5.7% National Trend
Benefit Changes
No Benefit Changes Made
2020-21 Plan Year
3.0% OPEH&W Rate Increase
7.9% National Trend
Benefit Changes
Added Zero Out-of-Pocket Medical Procedures
Added Health Advocacy Solutions from BlueCross
Added Connect360 from Express Scripts
Removed CAT/MRI $100 Failure to Call-In Penalty
Added Free Cash Rewards for Members from Vitals
Added Free Hypertension & High Cholesterol Program from Omada
Added Free Diabetes Program from Livongo
Added Free Physical Therapy Program from Hinge
Added Free Fertility, Pregnancy & Parenting Support from Ovia
Added Free Health & Wellness Program from Well onTarget
Added Free Weight-Loss Program from Naturally Slim
Added Enhanced Dental Plan
2019-20 Plan Year
4.0% OPEH&W Rate Increase
6.9% National Trend
Benefit Changes
4 New Health Coverage Options Added - Platinum, Gold, Silver & Bronze. Existing Health Coverage Option re-named as Diamond
Diamond Health Coverage Option - Rx Non-Preferred Brand Name Coverage Tier create with a $60 Co-Pay
Diamond & Platinum Health Coverage Options - Medical In-Network Maximum Out-of-Pocket lowered to $3,000 for an Individual, upto a maximum of $6,000 for Families of 2 or more
Diamond & Platinum Health Coverage Options - Medical Out-of-Network Maximum Out-of-Pocket lowered to $6,000 for an Individual, upto a maximum of $12,000 for Families of 2 or more
2018-19 Plan Year
2.5% Rate Increase
7.5% National Trend
Benefit Changes
Added Orthodontic Dental Services (Dependent Children Only)
$1,500 Lifetime Maximum
50% Coinsurance
Not Subject to Deductible
No Waiting or Elimination Periods
2017-18 Plan Year
7.4% Rate Increase
8.0% National Trend
Benefit Changes
In-Network Medical Plan Year Deductible for individuals unchanged at $750, family decreased to $1,500
In-Network Medical Plan Year Max Out-of-Pocket for individuals increased to $5,000, family decreased to $10,000
Out-of-Network Medical Plan Year Deductible for individuals increased to $1,500, family increased to $3,000
Out-of-Network Medical Plan Year Max Out-of-Pocket for individuals increased to $10,000, family increased to $20,000
In-Network Rx Plan Year Max Out-of-Pocket for individuals increased to $2,000, family decreased to $4,000
Dependent Child Group Life Coverage regardless of age, a dependent child's group life benefit is now 10% of the emplpoyee's group life benefit. Previously, the maximum was $500 for dependent children under 6-months
2016-17 Plan Year
7.5% Rate Increase
7.8% National Trend
Benefit Changes
In-Network Deductible increased to $750
Out-of-Network Deductible decreased to $750
Medical Network: Medical network changed from the BlueCross BlueChoice network to the BluePreferred network
ConnectDME has been made the Health Plan’s vendor for medical equipment, it will provide medical equipment and supplies for Free
CatapultHealth - Health Screenings has been made the Health Plan’s vendor for on-site Wellness Screenings, screenings remain free to the Member and Group, any member or spouse receiving a screening will receive a $250 reduction in medical deductible at the start of the following plan year
MDLIVE provides $0 office visit co-pays for non-emergency face-to-face primary care services through mobile app or web interface or, $0 office visit co-pays for behavioral health services through the same mobile app or web interface
Pre Service or Procedure Member Care with the Benefits Value Advisor is a free and optional service for use prior to receiving medical services or procedures. Assists with locating providers offering the higher quality outcomes and lowest out-of-pocket costs. Also, offers help and support in multiple related areas linked to the condition, service or procedure.
2015-16 Plan Year
0.0% Rate Increase
3.9% National Trend
Benefit Changes
Specialty Drugs Coverage split into 3 cost tiers, Generics $10, Preferred Brands $60, Non-Preferred Brands $100
Rx In-Network Out-of-Pocket Limit created Annual In-Network Out-of-Pocket Maximum of $1,900 per individual per plan year, up to a maximum of $5,700 for a family of 3 or more
Rx Drug Exclusions added for some Brand Names where adirect thetapeutic alternatives exist
2014-15 Plan Year
1.5% Rate Increase
5.3% National Trend
Benefit Changes
Medical In-Network Out-of-Pocket Limit created and set at $2,500 per individual per plan year, up to a maximum of $7,500 for a family of 3 or more
Medical In-Network & Out-of-Network Co-Insurance separated
Wigs or Other Scalp Prostheses' the play year maximum of $150 has been removed
Dependent Maternity Care now covered
Co-Pay for Specialty Rx increased from $40 to $60
Nexium Over-The-Counter now covered at a $0 Co-Pay (with a prescription)
Nasacort Over-The-Counter now covered at a $5 Co-Pay (with a prescription)
Pre-Existing Conditions no longer considered
Domestic Partnerships will now be allowed for same-gender Domestic Partnerships
2013-14 Plan Year
0.0% Rate Increase
4.1% National Trend
Benefit Changes
Contraception Rx Co-Pay reduced from $10 to $0
Smoking Cessation Drugs coverage added of 6-months each plan year at a $0 Co-Pay
2012-13 Plan Year
5.0% Rate Increase
6.1% National Trend
Benefit Changes
Office Visit Co-Pay reduced from $25 to $20
Medical In-Network Co-Insurance reduced from 30%/$3,000 to 20%/$2,000
Dependent Child Deductible reimbursement added for amounts paid over $250
2011-12 Plan Year
8.5% Rate Increase
8.5% National Trend
Benefit Changes
Rx Brand Name Deductible added for $50
Medical Out-of-Network Deductible added at $1,000
Office Visit Co-Pay added at $25 for Primary Care & $50 for Specialists
Medical In-Network Co-Insurance increased from 20%/$2,000 to 30%/$3,000
Lifetime & Plan Year Maximums limits removed
2010-11 Plan Year
6.0% Rate Increase
6.9% National Trend
Benefit Changes
Deductible increased from $400 to $500
Generic Rx Co-Pay increased from $5 to $10
2009-10 Plan Year
5.0% Rate Increase
6.3% National Trend
Benefit Changes
No Benefit Changes Made
2008-09 Plan Year
5.0% Rate Increase
6.0% National Trend
Benefit Changes
No Benefit Changes Made
