2027 Plan
HMO-POS
BlueCHiP for Medicare Extra
Extra may be right for you if you'd prefer to pay a higher monthly premium in exchange for lower out-of-pocket costs when you need care.
Currently viewing 2027 plan details.
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What's included
Prescription drug coverage
$450 drug deductible, $0 Tier 1 & 2 copays
Flexible Benefit Card
$40/quarter for over-the-counter (OTC) everyday health items
Dental
Preventive and comprehensive dental coverage (up to $2,500/year); includes coverage for crowns (50%)
Vision & hearing
$0 annual routine vision and hearing exams, plus a $300/year eyewear allowance and coverage for hearing aids
Fitness benefits
$0/month fitness center membership
Medical benefits at a glance
PCP visit
Visits to in-network primary care provider
$0 copay
Specialist visit
$0-$35 copay per visit in-network
$0-$35 copay
Preventive care
In-network preventive screenings and exams
$0 copay
Emergency care
Emergency coverage available worldwide
$130 copay per visit
Outpatient surgery
Copay may be lower at in-network ambulatory surgery center
$0-$400 copay per visit
Inpatient hospital stay
Copay is per day for days 1-6 at in-network hospitals
$325 copay per day
Prescription drug coverage
Prescription deductible
$450
Tier 1 (Preferred Generic)
$0 copay
Tier 2 (Generic)
$0 copay
Tier 3 (Preferred Brand)
25% coinsurance after deductible
Tier 4 (Non-preferred Drug)
30% coinsurance after deductible
Tier 5 (Specialty Tier)
28% coinsurance after deductible
Plan documents
2027 Annual Notice of Changes
2027 Enrollment Form
2027 Evidence of Coverage
2027 Plan Change Form