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Health & Wellness

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Benefit Summaries

PW_A122314

EmployeeElect Plans

To view specific details of each Plan, click on the English or Spanish version, as appropriate. 
Open Access HMO Plans (effective 07/01/10)  

OA HMO Plan $40/$2,000/70% (6801AX)*  
OA HMO Plan $25/$1,000/100% (6009AX)*  
OAHMO Plan $25/$500/100% (6005AX)*  
OA HMO Plan $25/$0/100% (6004AX)*  
 
* The Gatekeeper versions of these plans are also available (6800SX, 6009SX, 6001SX, 6000SX).  
 
Open Access POS Plans (effective 07/01/10)  

OA POS Plan $25/$1,000/100% (5010AX)* 
OA POS Plan $25/$500/80% (5506AX)* 
OA POS Plan $25/$500/100% (5007AX)* 
OA POS Plan $25/$0/100% (5006AX)* 
 
* The Gatekeeper versions of these plans are also available (5010SX, 5501SX, 5002SX, 5001SX).  
 
PPO Plans (effective 07/01/10)  

PPO Plan $25/$2,000/100% (4003SX)  
PPO Plan $40/$1,500/80% (4502SX)  
PPO Plan $25/$1,000/80% (4510SX)  
PPO Plan $25/$1,000/90% (4204SX)  
PPO Plan $25/$500/80% (4503SX)  
PPO Plan $25/$500/90% (4201SX)  
PPO Plan $25/$0/100% (4001SX)  
 
Lumenos Consumer-Driven Open Access POS Plans (effective07/01/10)  

CDHP (GHSA8)*  
 
CDHP HSA Plan (GEHSA8 w/embedded ded)*  
 
CDHP HSA Plan (GHSA12)*  
 
CDHP HSA Plan (GEHSA12 w/embedded ded)*  
 
CDHP HRA Plan (GHRA31)*  
 
CDHP HRA Plan (GHRA113)*  
 
 
*The Lumenos Consumer-Driven PPO versions of these plans are also available (GHSA46, GHSA58, GHSA50, GHSA62, GHRA127, GHRA141).  
 
Lumenos Consumer-Driven Open Access POS Plans w/Rx Copays (effective07/01/10)  

CDHP HSA Plan (GHSA177)* 
 
CDHP HSA Plan (GHSA181 w/embedded ded)*  
 
CDHP HSA Plan (GHSA178)*  
 
CDHP HSA Plan (GEHSA182 w/embedded ded)*  
 
CDHP HRA Plan (GHRA272)* 
 
CDHP HRA Plan (GHRA276)* 
 
 
*The Lumenos Consumer-Driven PPO versions of these plans w/Rx Copays are also available (GHSA105, GHSA109, GHSA106, GHSA110, GHRA224, GHRA228).  
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.