MEDICAL PLAN OPTIONS 2026 Benefits Guide | 11 Blue Cross Blue Shield of MA HMO (with HRA ) Blue Cross Blue Shield of MA PPO HSA (with HRA ) Blue Cross Blue Shield of MA PPO HSA Only In - Network Only In - Network / Out - of - Network* In - Network / Out - of - Network* Plan Deductible $6,000 member / $12,000 family $6,000 member / $12,000 family $6,000 member / $12,000 family BB&N Pays via HRA $5,000 member / $10,000 family $4,000 member / $8,000 family - Employee Deductible Responsibility $1,000 member / $2,000 family $2,000 member / $4,000 family** $6,000 member / $12,000 family BB&N HSA Contribution - $1,000 member / $2,000 family $2,000 member / $4,000 family Net Employee Deductible Responsibility $1,000 member / $2,000 family $1,000 member / $2,000 family** $4,000 member / $8,000 family Out - of - Pocket Maximum $8,000 member / $16,000 family $8,000 member / $16,000 family $8,000 member / $16,000 family Net Employee OOP Max $1,000 member / $2,000 family $1,000 member / $2,000 family $6,000 member / $12,000 family Preventive Visit $0 $0 $0 to employee after deductible $0 20% coinsurance after deductible PCP Office Visit $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible Specialist Office Visit $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible Emergency Room Visit $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible Diagnostic X - Ray & Lab $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible High Tech Imaging $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible Inpatient Care $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible Outpatient Care $0 to employee after deductible $0 to employee after deductible $0 after deductible 20% coinsurance after deductible *PPO Plan: For Out - of - Network claims that are submitted to BCBSMA/HealthEquity there may be b alance billing due for the difference between the provider’s charge and BCBSMA allowed charge. B alance billing amounts are completely outside of the medical plan and your responsibility. Please refer to the medical plan certific at e for more information. ** F amily Deductible: A ll members in a family plan will contribute towards the family deductible, with no per member cap before the full deductible res po nsibility is met.