Medical & Rx
Administered by Blue Cross Blue Shield of Texas
FirstCall offers several medical plan options to meet the needs of you and your family, wherever you might be on life's journey. There are three Preferred Provider Organization (PPO) plans to choose from. Blue Cross Blue Shield of Texas is the carrier of our medical plans and Express Scripts by Evernorth is now the Pharmacy Benefit Manager (PBM). In-network benefits are covered under the Blue Options network for all three plans.
Terms to Know Before You Begin
PPO
Preferred Provider Organization (PPO) plans allow members to use any healthcare professional without a referral. Staying in-network means smaller copays and more coverage. If you go out-of-network, you'll have higher out-of-pocket costs, and not all services may be covered.
Deductible
Total dollar amount, based on the allowed amount, you must pay out of pocket for covered medical expenses each calendar year before the plan pays for most services. The deductible does not apply to in-network preventive care and any services where you pay a co-payment rather than coinsurance.
Embedded
There are two parts to a plan with an embedded deductible. The first is an individual deductible, which applies to each family member, and the second is an overall family deductible. When an individual meets their deductible, the insurance company will begin paying according to the plan’s coverage for that member. When the family deductible or out-of-pocket maximum is reached, coverage begins for everyone.
Coinsurance
A percentage of the medical costs, based on the allowed amount, you must pay for certain services after you meet your annual deductible. For example: If your coinsurance is 90 percent, insurance pays 90 percent and you pay 10 percent.
Copay
A copayment (copay) is a set dollar amount you pay for in-network doctors’ office visits, emergency room services and prescription drugs.
Out-of-Pocket Maximum
The maximum amount of coinsurance a Plan member must pay toward covered medical expenses in a calendar year for both network and non-network services. Once you meet this out-of- pocket maximum, the Plan pays the entire coinsurance amount for covered services for the remainder of the calendar year. Deductibles and copays apply to the annual out-of-pocket maximum.
Click to visit the glossary on the Resources page for more benefits terms.
Medical Plan Highlights
Blue Cross Blue Shield of Texas | Blue Options Network
HSA-Eligible
PPO Base (HDHP)
In-Network
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)
$5,000 / $10,000
Your Coinsurance
0%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit (Primary Care / Specialist)
Deductible, then covered 100%
Preventive Care Services
Covered 100%
Hospital Services
Deductible, then covered 100%
Urgent Care Visit
Deductible, then covered 100%
Emergency Room Visit
Deductible, then covered 100%
Out-of-Network
Plan Year Deductible (Individual / Family)
$8,000 / $16,000
Your Coinsurance
30%
Out-of-Pocket Maximum (Individual / Family)
$9,250 / $19,750
PPO Mid
In-Network
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)
$3,000 / $6,000
Your Coinsurance
20%
Out-of-Pocket Maximum (Individual / Family)
$6,000 / $12,000
Physician Visit (Primary Care / Specialist)
$25 / $50 copay
Preventive Care Services
Covered 100%
Hospital Services
Deductible, then coinsurance
Urgent Care Visit
$50 copay
Emergency Room Visit
$500 copay
Out-of-Network
Plan Year Deductible (Individual / Family)
$6,000 / $12,000
Your Coinsurance
50%
Out-of-Pocket Maximum (Individual / Family)
$12,000 / $24,000
PPO Buy-Up
In-Network
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)
$1,500 / $3,000
Your Coinsurance
20%
Out-of-Pocket Maximum (Individual / Family)
$3,500 / $7,000
Physician Visit (Primary Care / Specialist)
$25 / $50 copay
Preventive Care Services
Covered 100%
Hospital Services
Deductible, then coinsurance
Urgent Care Visit
$50 copay
Emergency Room Visit
$300 copay
Out-of-Network
Plan Year Deductible (Individual / Family)
$3,000 / $6,000
Your Coinsurance
50%
Out-of-Pocket Maximum (Individual / Family)
$7,000 / $14,000
Your Medical plan is administered by Blue Cross Blue Shield of Texas.
Contact the provider of these benefits by calling this phone number or visiting this website: BCBS of Texas - (800) 521-2227, www.bcbstx.com
Blue Access for Members
Through Blue Cross Blue Shield our secure member website, you can access health plan information, resources and tools.
Find a Provider
Find out if your doctor, drug, or pharmacy is in-network, or explore other care options.
Mobile App
Find in-network doctors or hospitals, access and download your digital ID card, review your claims and coverage information and more.
Health & Wellbeing Programs
Help managing your health conditions, get pregnancy support, talk to a nurse 24/7 and more.
Prescription (Rx) Plan Highlights
Express Scripts by Evernorth | Specialty through Accredo
HSA-Eligible
PPO Base
Retail (30-day supply)
Tier 1 - Generic
Deductible, then covered 100%
Tier 2 - Preferred Brand
Deductible, then covered 100%
Tier 3 - Brand Name
Deductible, then covered 100%
Tier 4 - Non-Preferred Brand
Deductible, then covered 100%
Tier 5 - Specialty (through Accredo)
Deductible, then covered 100%
PPO Mid
Retail (30-day supply)
Tier 1 - Generic
$10 copay
Tier 2 - Preferred Brand
$25 copay
Tier 3 - Brand Name
$35 copay
Tier 4 - Non-Preferred Brand
$75 copay
Tier 5 - Specialty (through Accredo)
25% coinsurance
PPO Buy-Up
Retail (30-day supply)
Tier 1 - Generic
$10 copay
Tier 2 - Preferred Brand
$15 copay
Tier 3 - Brand Name
$35 copay
Tier 4 - Non-Preferred Brand
$50 copay
Tier 5 - Specialty (through Accredo)
25% coinsurance
Your Pharmacy Benefits Manager is Express Scripts through Evernorth.
Contact the provider of these benefits by calling this phone number or visiting this website: Express Scripts - (800) 282-2881, www.express-scripts.com
Register with Express Scripts
Create an online account to access your prescription benefit information in one place. You can view your digital ID card, check medication coverage, review claims, and manage prescriptions anytime.
Express Scripts Mobile App
The Express Scripts mobile app gives you convenient access to your pharmacy benefits from your phone. Use it to check medication costs, find a network pharmacy, set reminders, and track your prescriptions on the go.
Formulary List
The formulary is a list of medications covered under your prescription drug plan. Reviewing the list can help you understand which medications are covered and identify lower-cost alternatives that may be available.
Exclusions & Alternatives
Some medications are not covered under the prescription plan and may have preferred alternatives available. This resource helps you compare excluded medications with covered options and understand what alternatives may be available.
Contribution Rates
Rates Per Weekly Pay Period (52 Per Year)
Employee Only
PPO Base
$0.00
PPO Mid
$45.65
PPO Buy-Up
$68.90
Employee & Spouse
PPO Base
$104.15
PPO Mid
$171.09
PPO Buy-Up
$222.14
Employee & Child(ren)
PPO Base
$55.02
PPO Mid
$101.94
PPO Buy-Up
$134.76
Employee & Family
PPO Base
$111.46
PPO Mid
$211.22
PPO Buy-Up
$263.07
Questions?
Call the Care Line at (877) 835-1361.
Care Line is an NFP-sponsored program that is staffed by dedicated professionals to help you understand the benefit options made available to you. Whether you have concerns about a recent claim or bill, finding an in-network doctor or just some guidance on which medical plan is right for you and your family, the Care Line can help educate and advocate.
The Care Line is open Monday through Friday from 9:00 am - 6:00 pm ET.
For questions related to your benefits (enrollment, coverage, etc.), our Benefits Concierge team is here to help, email dbbenadmin@nfp.com.
For any claims-related issues, please reach out to our dedicated Claims Specialists, email csclaims@nfp.com.
FirstCall Benefits Team
Our very own internal Benefits Team is at your disposal. If you have any questions about your benefits, need help understanding eligibility or the enrollment process, or experience a qualifying life event, please contact us at benefits@firstcallmechanical.com.
NOTE: In the event there is any discrepancy between the descriptions of the program elements contained within this Digital Benefits Guide and the official plan documents, the language of the official plan documents shall prevail. Please refer to the plan-specific documents published by each of the respective carriers or third-party administrators for detailed plan information. You should be aware that any and all elements of our Benefits Program may be modified in the future to meet Internal Revenue Service rules, or otherwise as determined by FirstCall Group.