Small Group Coverage
STATEWIDE ACCESS -
All plans include networks with statewide access to doctors, hospitals and clinics. The Awareฎ Network provides a broader choice in providers, while the Group Value and High Value networks have a more narrow provider network to choose from.

ONLINE TOOLS AND RESOURCES
Employers and Menbers can easily view and manage health plan benefits online.
BlueAccessSM -
with the Aware Network offers easy access to the most health care providers across the state.
BlueValueSM -
with the Group Value Network provides access to key health care providers throughout most of the state while offering a lower-cost plan option.
High Value -
with the High Value Network offers access to providers across the state. This network offers more cost savings, but the smallest network of providers.
COVERAGE THAT TRAVELS WITH YOU
All plans offer the BlueCardฎ PPO network when traveling outside Minnesota. The BlueCard PPO network covers 92 percent of doctors and 96 percent of hospitals nationwide. In addition, members have access to doctors and hospitals in countries around the world with Blue Cross Blue Shield Global Core (Formerly known as BlueCard Worldwideฎ)
Overview and Comparison of Plan Benefits
IN-NETWORK BENEFITS BlueAccessSM - WITH AWARE NETWORK
Plan number 624 620 634 640 627 642 645 632 625
Deductible
• Single
• Family

$6,650
$13,300 (embedded)

$5,200
$10,400 (embedded)

$5,000
$10,000

$4,500
$9,000 (embedded)

$3,700
$7,400

$3,675
$7,350 (non-embedded)

$3,600
$7,200 (embedded)

$2,700
$5,400 (embedded)

$2,700
$5,400
Compatible with HSA or HRA HSA HSA HRA HSA HRA HSA HSA HSA No
Coinsurance 0% 25% 25% 0% 25% 0% 0% 20% 40%
Out-of-pocket maximum
• Single
• Family

$6,650
$13,300

$6,650
$13,300

$7,350
$14,700

$4,500
$9,000

$7,350
$14,700

$3,675
$7,350

$3,600
$7,200

$4,100
$8,200

$7,350
$14,700
Office visits
• Healh care provider
  or urgent care clinic
• Specialist

• Retail health clinic

• E-visits

0% after deductible
0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible
25% after deductible

$40

$60

$20

First 3 visits free,* then $40 copay

0% after deductible
0% after deductible
0% after deductible
0% after deductible

$40

$60

$20

First 3 visits free,* then $40 copay

0% after deductible
0% after deductible
0% after deductible
0% after deductible

0% after deductible
0% after deductible
0% after deductible
0% after deductible

20% after deductible
20% after deductible
20% after deductible
20% after deductible

$40

$60

$20

First 3 visits free,* then $40 copay
Preventive care 0% (no deductible)
Prescription drugs
• Preferred generic

• Preferred brand

• Non-preferred

0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible

$10

$50

$150

0% after deductible
0% after deductible
0% after deductible

$10

$50

$150

0% after deductible
0% after deductible
0% after deductible

0% after deductible
0% after deductible
0% after deductible

20% after deductible
20% after deductible
20% after deductible

$10

$50

$150
Preventive drugs 0% (no deductible) 0% (no deductible) Not applicable 0% (no deductible) Not applicable 0% (no deductible) 0% (no deductible) 0% (no deductible) Not applicable
IN-NETWORK BENEFITS BlueAccessSM - WITH AWARE NETWORK
Plan number 623 653 629 637 647 641 635 643 655
Deductible
• Single
• Family
$2,300
$4,600
$2,200
$4,400 (non-embedded)
$1,500
$3,000 (non-embedded)
$1,000
$2,000
$1,000
$2,000
$750
$1,500
$500
$1,000
$300
$600
$0
$0
Compatible with HSA or HRA No HSA HSA No HRA No No No No
Coinsurance 25% 0% 10% 20% 20% 20% 20% 25% 10%
Out-of-pocket maximum
• Single
• Family

$7,350
$14,700

$2,200
$4,400

$3,500
$7,000

$4,300
$8,600

$4,300
$8,600

$6,500
$13,000

$6,500
$13,000

$6,500
$13,000

$3,500
$7,000
Office visits
• Healh care provider
  or urgent care clinic
• Specialist

• Retail health clinic

• E-visits

25% after deductible

25% after deductible

25% after deductible

First 3 visits free,* then 25% after deductible

0% after deductible
0% after deductible
0% after deductible
0% after deductible

10% after deductible
10% after deductible
10% after deductible
10% after deductible

$30

$50

$10

First 3 visits free,* then $30 copay

$30

$50

$10

First 3 visits free,* then $30 copay

$30

$50

$10

First 3 visits free,* then $30 copay

$30

$50

$10

First 3 visits free,* then $30 copay

$30

$50

$10

First 3 visits free,* then $30 copay

$20

$40

$10

First 3 visits free,* then $20 copay
Preventive care 0% (no deductible)
Prescription drugs
• Preferred generic

• Preferred brand

• Non-preferred

$10

$50

$150

0% after deductible
0% after deductible
0% after deductible

10% after deductible
10% after deductible
10% after deductible

$10

$50

$150

$10

$50

$150

$10

$50

$150

$10

$50

$150

$10

$50

$150

$10

$50

$150
Preventive drugs Not applicable 0% (no deductible) 0% (no deductible) Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
IN-NETWORK BENEFITS BlueValueSM - WITH GROUP VALUE NETWORK High Value - WITH HIGH VALUE NETWORK
Plan number 676 654 677 678 680 682 656 658 660 662 664
Deductible
• Single
• Family

$6,650
$13,300 (embedded)

$5,200
$10,400 (embedded)

$3,600
$7,200 (embedded)

$2,300
$4,600

$1,000
$2,000

$0
$0

$6,650
$13,300 (embedded)

$5,200
$10,400 (embedded)

$3,600
$7,200 (embedded)

$2,300
$4,600

$1,000
$2,000
Compatible with HSA or HRA HSA HSA HSA No No No HSA HSA HSA No No
Coinsurance 0% 25% 0% 25% 20% 10% 0% 25% 0% 25% 20%
Out-of-pocket maximum
• Single
• Family

$6,650
$13,300

$6,650
$13,300

$3,600
$7,200

$7,350
$14,700

$4,300
$8,600

$3,500
$7,000

$6,650
$13,300

$6,650
$13,300

$3,600
$7,200

$7,350
$14,700

$4,300
$8,600
Office visits
• Healh care provider
  or urgent care clinic
• Specialist

• Retail health clinic

• E-visits

0% after deductible
0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible
25% after deductible

0% after deductible
0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible
First 3 visits free,* then 25% after deductible

$30
$50
$10
First 3 visits free,* then $30 copay

$20
$40
$10
First 3 visits free,* then $20 copay

0% after deductible
0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible
25% after deductible

0% after deductible
0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible
First 3 visits free,* then 25% after deductible

$30
$50
$10
First 3 visits free,* then $30 copay
Preventive care 0% (no deductible)
Prescription drugs
• Preferred generic

• Preferred brand

• Non-preferred

0% after deductible
0% after deductible
0% after deductible

25% after deductible
25% after deductible
25% after deductible

0% after deductible
0% after deductible
0% after deductible

$10

$50

$150

$10

$50

$150

$10

$50

$150

$0 after deductible
$0 after deductible
No coverage

25% after deductible
25% after deductible
No coverage

0% after deductible
0% after deductible
No coverage

$10

$50

No coverage

$10

$50

No coverage
Preventive drugs 0% (no deductible) 0% (no deductible) 0% (no deductible) Not applicable Not applicable Not applicable 0% (no deductible) 0% (no deductible) 0% (no deductible) Not applicable Not applicable