Health Benefit Summaries & Details
Health Plans
Blue Cross Community Blue PPO Plans
| Plan |
SBC |
BAAG |
| Active Employees of Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Community Blue PPO $500 SBC(PDF, 2MB) |
Community Blue PPO $500 BAAG(PDF, 222KB) |
| Pre-Medicare Retirees of Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Community Blue PPO $500 SBC(PDF, 2MB) |
Community Blue PPO $500 BAAG(PDF, 222KB) |
| Medicare-Eligible Retirees of POAM, Legislative Branch Exempt (including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Not Required |
Medicare Plus Blue Group PPO (Option 3) BAAG(PDF, 1MB) |
Blue Cross Simply Blue High Deductible Health Plans (HDHP) PPO
| Plan |
SBC |
BAAG |
| Active Employee of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Simply Blue HDHP PPO 10% SBC(PDF, 2MB) |
Simply Blue HDHP PPO 10% BAAG(PDF, 244KB) |
| All Other Benefit-Eligible Active Employees |
Simply Blue HDHP PPO 20% SBC(PDF, 2MB) |
Simply Blue HDHP PPO 20% BAAG(PDF, 244KB) |
| Pre-Medicare Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Simply Blue HDHP PPO 10% SBC(PDF, 2MB) |
Simply Blue HDHP PPO 10% BAAG(PDF, 244KB) |
| Medicare-Eligible Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Not Required |
BAAG |
| All Other Pre-Medicare-Eligible Retirees (Excludes retirees eligible under Retiree Stipend Program) |
Simply Blue HDHP PPO 20% SBC(PDF, 2MB) |
Simply Blue HDHP PPO 20% BAAG(PDF, 244KB) |
| All Other Medicare-Eligible Retirees (Excludes retirees eligible under Retiree Stipend Program) |
Not Required |
Medicare Plus Blue Group PPO (Option 1) BAAG(PDF, 1MB) |
Blue Care Network (BCN) Full Provider Network HMO Plans
| Plan |
SBC |
BAAG |
| Active Employees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Blue Care Network HMO $500 SBC(PDF, 2MB) |
Blue Care Network HMO $500 BAAG(PDF, 98KB) |
| All Other Benefit-Eligible Active Employees |
Blue Care Network HMO HDHP 20% Full Net SBC(PDF, 2MB) |
BAAG(PDF, 150KB) |
| Pre-Medicare Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Blue Care Network HMO $500 SBC(PDF, 2MB) |
Blue Care Network HMO $500 BAAG(PDF, 98KB) |
| Medicare-Eligible Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Not Required |
Blue Care Network HMO-POS (Legislative) BAAG(PDF, 394KB) |
| All Other Pre-Medicare Benefit-Eligible Retirees (Excludes retirees eligible under Retiree Stipend Program) |
Blue Care Network HMO HDHP 20% Full Net SBC(PDF, 2MB) |
BAAG(PDF, 150KB) |
| All Other Medicare-Eligible Retirees (Excludes retirees eligible under Retiree Stipend Program) |
Not Required |
BAAG |
Blue Care Network (BCN) PCP Focus HMO Plans+
| Plan |
SBC |
BAAG |
| All Active Employees Excluding Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA Employees |
Blue Care Network HDHP with PCP SBC(PDF, 2MB) |
Blue Care Network HDHP with PCP BAAG(PDF, 109KB) |
| Pre-Medicare Benefit-Eligible Retirees Excluding Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA, and retirees eligible under Retiree Stipend Program |
Blue Care Network HDHP with PCP SBC(PDF, 2MB) |
Blue Care Network HDHP with PCP BAAG(PDF, 109KB) |
| Medicare-Eligible Retirees Excluding Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA, and retirees eligible under Retiree Stipend Program |
Not Required |
Blue Care Network HMO-POS (Full Panel) BAAG(PDF, 322KB) |
Blue Care Network (BCN) PCP Focus Copay HMO Plans
| Plan |
SBC |
BAAG |
| Active Employees Excluding Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
BCN PCP Focus Copay HMO SBC(PDF, 667KB) |
BCN PCP Focus Copay HMO BAAG(PDF, 462KB) |
| All Other Benefit-Eligible Active Employees |
BCN PCP Focus Copay HMO SBC(PDF, 667KB) |
BCN PCP Focus Copay HMO BAAG(PDF, 462KB) |
| Pre-Medicare Benefit-Eligible Retirees Excluding Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA and retirees eligible under Retiree Stipend Program |
HMO PCP Focus Copay SBC(PDF, 1MB) |
BCN PCP Focus Copay HMO BAAG(PDF, 462KB) |
| Medicare-Eligible Retirees Excluding Retirees of Legislative Branch Exempt (Including Elected Officials & Judges), 3rd Circuit GAA, JAA |
Not Required |
Blue Care Network HMO-POS (Focus Copay) BAAG(PDF, 323KB) |
ACA Minimum Value Plan-Blue Cross Simply Blue HDHP
| Plan |
SBC |
BAAG |
| Plan for Employees Working 30 or More Hours Per Week on Average |
SBC |
BAAG |
*For provider (find care) or drug-prescription lists, please visit BCBSM / BCN website,
Dental Plans
Delta Dental Plans
General Information:
Employee Plans:
Retiree Plan: For enrollment on this plan, please contact TMR and Associates, Inc.
- Delta Dental PPO Standard (Retirees) BAAG/Fee Schedule
*For provider list, please visit Delta Dental website.
DENCAP Dental Plans
General Information:
Employee Plans:
Retiree Plans: For enrollment and additional information on this plan, please contact TMR and Associates, Inc.
- DENCAP Dental DHMO Voluntary Retiree Dental Plan BAAG/Fee Schedule
- DENCAP Dental Retiree Advantage Plan (Retirees Only) BAAG/Fee Schedule
*For provider list, please visit DENCAP Dental website.
Vision Plans