Benefits at a Glance - BCBSM

Enhanced Traditional PPO Plans

The Pool's Traditional PPO plans offer our most comprehensive coverage. Most plans cover services like wisdom tooth extraction and therapeutic massage, in addition to 24 chiropractic visits per year. Benefits at a Glance documents are categorized below by their single deductible amount.

 

 

The Pool's Traditional PPO plans offer our most comprehensive coverage. Most plans cover services like wisdom tooth extraction and therapeutic massage, in addition to 24 chiropractic visits per year. Benefits at a Glance documents are categorized below by their single deductible amount.

 

 

 

BCBSM's Member Handbook:

ENHANCED Traditional PPO Plans

 

Looking for a plan's formulary?

Find the comprehensive list here.

 

$0 Deductible

$250 Deductible

$500 Deductible

$1000+ Deductible

ENHANCED 0 009

ENHANCED 0 010

ENHANCED 0 011

ENHANCED 0 012

ENHANCED 0 013

ENHANCED 0 097

ENHANCED 0 113

ENHANCED 0 124

ENHANCED 250 001

ENHANCED 250 002

ENHANCED 250 003

ENHANCED 250 005

ENHANCED 250 006

ENHANCED 250 007

ENHANCED 250 014

ENHANCED 250 015

ENHANCED 250 018

ENHANCED 250 019

ENHANCED 250 024

ENHANCED 250 025

ENHANCED 250 027

ENHANCED 250 028

ENHANCED 250 051

ENHANCED 250 052

ENHANCED 250 061

ENHANCED 250 063

ENHANCED 250 105

ENHANCED 250 123

ENHANCED 250 125

ENHANCED 250 144

ENHANCED 250 148

ENHANCED 250 177

ENHANCED 500 004

ENHANCED 500 008

ENHANCED 500 016

ENHANCED 500 017

ENHANCED 500 020

ENHANCED 500 021

ENHANCED 500 030

ENHANCED 500 062

ENHANCED 500 065

ENHANCED 500 068

ENHANCED 500 101

ENHANCED 500 111

ENHANCED 500 118

ENHANCED 500 147

ENHANCED 500 151

ENHANCED 500 159

ENHANCED 500 160

ENHANCED 500 174

ENHANCED 500 178

ENHANCED 1000 029

ENHANCED 1000 049

ENHANCED 1000 089

ENHANCED 1000 100

ENHANCED 1000 112

ENHANCED 1000 117

ENHANCED 1000 143

ENHANCED 1000 171

ENHANCED 1000 173

ENHANCED 1000 179

ENHANCED 1000 198

 

 

Benefits at a Glance - BCBSM

Value Traditional PPO Plans

The Pool's Value plans provide comprehensive coverage while being mindful of premium costs. Plans include 12 chiropractic visits per year and first dollar coverage for office visits and prescriptions.

 

 

The Pool's Value plans provide comprehensive coverage while being mindful of premium costs. Plans include 12 chiropractic visits per year and first dollar coverage for office visits and prescriptions.

 

 

 

 

 

BCBSM's Member Handbook:

VALUE PPO Plans

 

Looking for a plan's formulary?

Find the comprehensive list here.

 

$0 Deductible

$250 Deductible

$500 Deductible

$1000+ Deductible

VALUE 0 090

VALUE 250 091

VALUE 250 092

VALUE 250 093

VALUE 250 094

VALUE 250 110

VALUE 250 145

VALUE 250 152

VALUE 500 095

VALUE 500 114

VALUE 500 128

VALUE 500 146

VALUE 500 172

VALUE 1000 096

VALUE 1000 104

VALUE 1000 165

VALUE 2000 182

VALUE 3000 186/187

 

 

 

 

 

Benefits at a Glance - BCBSM

Enhanced HSA Plans

The Pool's Enhanced H.S.A. Plans pair the unique offerings of the enhanced platform, including 24 chiropractic visits per year, with the savings of a high deductible health plan and tax-free H.S.A.

 

 

The Pool's Enhanced H.S.A. Plans pair the unique offerings of the enhanced platform, including 24 chiropractic visits per year, with the savings of a high deductible health plan and tax-free H.S.A.

 

 

 

 

 

BCBSM's Member Handbook:

ENHANCED HSA Plans

 

Looking for a plan's formulary?

Find the comprehensive list here.

 

 

$1,600 Deductible

$2,000 Deductible

ENHANCED HSA LEVEL 034/035

ENHANCED HSA LEVEL 036/037

ENHANCED HSA LEVEL 038/039

ENHANCED HSA LEVEL 057/058

ENHANCED HSA LEVEL 119/120

ENHANCED HSA LEVEL 126/127

ENHANCED HSA LEVEL 131/132

ENHANCED HSA LEVEL 137/138

ENHANCED HSA LEVEL 141/142

ENHANCED HSA LEVEL 149/150

ENHANCED LEVEL 163/164

ENHANCED HSA 2000 040/041

ENHANCED HSA 2000 042/043

ENHANCED HSA 2000 044/045

ENHANCED HSA 2000 121/122

ENHANCED HSA 2000 175/176

 

Enhanced HSA Plan

Benefits at a Glance - BCBSM

Value HSA Plans

The Pool's Value H.S.A. plans are the most affordable plan options - Pairing a tax free H.S.A. account with your medical and Rx coverage, at a reduced premium cost.

 

 

 

The Pool's Value H.S.A. plans are the most affordable plan options - Pairing a tax free H.S.A. account with your medical and Rx coverage, at a reduced premium cost.

 

 

 

BCBSM's Member Handbook:

VALUE HSA Plans

 

Looking for a plan's formulary?

Find the comprehensive list here.

 

$1,600 Deductible

$2,000 Deductible

$3,000+ Deductible

$6,530 Deductible

VALUE HSA LEVEL 098/099

VALUE HSA LEVEL 108/109

VALUE HSA LEVEL 129/130

VALUE HSA LEVEL 133/134

VALUE HSA LEVEL 135/136

VALUE HSA LEVEL 139/140

VALUE HSA LEVEL 166/167

VALUE HSA LEVEL 168/169

VALUE HSA LEVEL 180/181

VALUE HSA 2000 102/103

VALUE HSA 2000 115/116

VALUE HSA 2000 153/154

VALUE HSA 2000 161/162

VALUE HSA 3000 046/047

VALUE HSA 3000 059/060

VALUE HSA 3000 066/067

VALUE HSA 3000 106/107

VALUE HSA 3000 183/184

VALUE HSA 3000 186/187

VALUE HSA 3500 155

VALUE HSA 3500 170

 

VALUE HSA 6350 157

 

Schedule of Benefits - BCBSM

 

 

Find your plan's Schedule of Benefits here.

 

 

 

 

 

 

 

 

 

 

Find your plan document(s) below.

 

ENHANCED PPO Plans

ENHANCED HSA Plans

VALUE PPO Plans

VALUE HSA Plans

ENHANCED 0 009
ENHANCED 0 010
ENHANCED 0 011
ENHANCED 0 012
ENHANCED 0 013
ENHANCED 0 097
ENHANCED 0 113
ENHANCED 0 124
ENHANCED 1000 029
ENHANCED 1000 049
ENHANCED 1000 089
ENHANCED 1000 100
ENHANCED 1000 112
ENHANCED 1000 117
ENHANCED 1000 143
ENHANCED 1000 171
ENHANCED 1000 173
ENHANCED 1000 179
ENHANCED 250 001
ENHANCED 250 002
ENHANCED 250 003
ENHANCED 250 005
ENHANCED 250 006
ENHANCED 250 007
ENHANCED 250 014
ENHANCED 250 015
ENHANCED 250 018
ENHANCED 250 019
ENHANCED 250 024
ENHANCED 250 025
ENHANCED 250 027
ENHANCED 250 028
ENHANCED 250 051
ENHANCED 250 052
ENHANCED 250 053
ENHANCED 250 055
ENHANCED 250 061
ENHANCED 250 063
ENHANCED 250 105
ENHANCED 250 123
ENHANCED 250 125
ENHANCED 250 144
ENHANCED 250 148
ENHANCED 250 177
ENHANCED 3000 186/187
ENHANCED 500 004
ENHANCED 500 008
ENHANCED 500 016
ENHANCED 500 017
ENHANCED 500 020
ENHANCED 500 021
ENHANCED 500 030
ENHANCED 500 054
ENHANCED 500 056
ENHANCED 500 062
ENHANCED 500 065
ENHANCED 500 068
ENHANCED 500 101
ENHANCED 500 111
ENHANCED 500 118
ENHANCED 500 147
ENHANCED 500 151
ENHANCED 500 159
ENHANCED 500 160
ENHANCED 500 174
ENHANCED 500 178

ENHANCED HSA 2000 040/041
ENHANCED HSA 2000 042/043
ENHANCED HSA 2000 044/045
ENHANCED HSA 2000 121/122
ENHANCED HSA 2000 175/176
ENHANCED HSA LEVEL 034/035
ENHANCED HSA LEVEL 036/037
ENHANCED HSA LEVEL 038/039
ENHANCED HSA LEVEL 057/058
ENHANCED HSA LEVEL 119/120
ENHANCED HSA LEVEL 126/127
ENHANCED HSA LEVEL 131/132
ENHANCED HSA LEVEL 137/138
ENHANCED HSA LEVEL 141/142
ENHANCED HSA LEVEL 149/150
ENHANCED LEVEL 163/164

VALUE 0 090
VALUE 1000 096
VALUE 1000 104
VALUE 1000 165
VALUE 2000 182
VALUE 250 091
VALUE 250 092
VALUE 250 093
VALUE 250 094
VALUE 250 110
VALUE 250 145
VALUE 250 152
VALUE 500 095
VALUE 500 114
VALUE 500 128
VALUE 500 146
VALUE 500 172
VALUE 3000 186/187

 

VALUE HSA 2000 102/103
VALUE HSA 2000 115/116
VALUE HSA 2000 153/154
VALUE HSA 2000 161/162
VALUE HSA 3000 046/047
VALUE HSA 3000 059/060
VALUE HSA 3000 066/067
VALUE HSA 3000 106/107
VALUE HSA 3000 183/184
VALUE HSA 3500 155
VALUE HSA 3500 170
VALUE HSA 6350 157
VALUE HSA LEVEL 098/099
VALUE HSA LEVEL 108/109
VALUE HSA LEVEL 129/130
VALUE HSA LEVEL 133/134
VALUE HSA LEVEL 135/136
VALUE HSA LEVEL 139/140
VALUE HSA LEVEL 166/167
VALUE HSA LEVEL 168/169
VALUE HSA LEVEL 180/181
Benefits at a Glance - Priority Health

Looking for Priority Health plan documents?

As each Priority Health plan is specific to your organization, please reach out to your Gallagher Service Team for your medical plan documents.

Not sure who to contact? Email ThePool.Admin@ajg.com 

 

 

As each Priority Health plan is specific to your organization, please reach out to your Gallagher Service Team for your medical plan documents.

Not sure who to contact? Email ThePool.Admin@ajg.com