Page 6 - Takoma Park Benefits Guide 2022

Medical Benefits

TPSS Co-Op provides medical benefits through CareFirst and offers the following two plan options:
Blue Preferred PPO HRA $2000 (Silver Plan)
» Large national network of participating providers when seeking care outside of the Service Area

» Benefits are covered In-Network and Out-of-Network
» Refer to the summary of benefits brochure for more details

Blue Choice HMO HRA $6100 (Bronze Plan)

» Limited to in-network benefits only.
» Must seek care from a Blue Choice HMO participating provider (Maryland/DC/Northern Virginia)
» Open Access- No referrals required to see a Specialist

» Must choose a primary care doctor at the time of enrollment.

Health Insurance Summary Comparison

BluePreferred BlueChoice
Benefits PPO HRA HMO HRA
Silver $2,000 Bronze $6,100
In-Network
Referral Needed No No

Copay
Primary Deductible then $25 copay Deductible then $50 copay
Specialist Deductible then $50 copay Deductible then $100 copay
Preventive Services

Adult Physical No Charge No Charge
Well Child Care No Charge No Charge
Deductible Aggregate Separate

Individual/Family $2,000 / $4,000 $6,100 / $12,200
Out of Pocket Separate Separate

Individual/Family $5,750 / $9,000 $6,900 / $13,800
Coinsurance 100% 100%
Hospital Deductible then $500 copay
Deductible then $500 copay
In-patient (3 day max per admission) Deductible then $450 copay
Out-patient Deductible then $400 copay
Diagnostic (Non-hospital)
Lab Tests Deductible then $25 copay Deductible then $50 copay
X-rays Deductible then $50 copay Deductible then $75 copay
Imaging Deductible then $250 copay Deductible then $250 copay
Emergency
Emergency Room Deductible then $250 copay Deductible then $250 copay
Urgent Care Deductible then $100 copay Deductible then $100 copay

Convenience Care Deductible then $25 copay Deductible then $50 copay