Comprehensive medical plans including pharmacy and vision Blue Solutions® health plans for small business employers
Our Blue Solutions portfolio helps meet the unique needs of small employers with cost-effective and innovative health plan designs, well-being programs, and value-added services. Choose from a wide variety of medical plans designed to help you lower costs and offer access to high-quality, affordable care. Our health plans cover all required essential health benefits — like in-office and virtual doctor visits, preventive care, hospital stays, emergency services, and prescription drugs — and include dental coverage for children, plus vision coverage for both adults and children.
All medical plans feature enhanced virtual care benefits, like telemedicine, teledermatology, and telebehavioral1 health services from Teladoc Health (Teladoc)® 2 and participating doctors and specialists who offer these services. Telenutrition visits are also available to members through their in-network nutritionist or a nutrition counselor via HUSK Nutrition, available through the HUSK Marketplace.
View/download our 2025 Blue Solutions overview brochure for complete details.
Personal Choice® PPO plans
PPO plans offer your employees the flexibility to choose in-network (preferred) or out-of-network (non-preferred) providers. However, much higher out-of-pocket costs may apply for out-of-network care. PPO plans do not require primary care physician (PCP) selection or referrals to access care. In-network benefits are available coast-to-coast through the BlueCard® PPO network and around the world through Blue Cross Blue Shield Global Core®.
Personal Choice® EPO plans
EPO plans give your employees access to any doctor or hospital in our PPO network, without requiring PCP selection or referrals. Out-of-network providers are not covered except for emergency and urgent care. EPOs combine the flexibility of a PPO and the cost savings of an HMO. In-network benefits are available coast-to-coast through the BlueCard® PPO network and around the world through Blue Cross Blue Shield Global Core®.
Keystone Direct POS plans
Direct POS plans provide both in- and out-of-network coverage, with the flexibility to visit most specialists without a referral. Emergency and urgent care access is also available outside the U.S.3 Members pay less for care in the Keystone Health Plan East network, and more when they go out-of-network.
Members must select a participating PCP to coordinate their care. To pay the lowest cost, members should get a referral or prescription from their PCP and visit designated sites for lab work, radiology, and physical and occupational therapy. The Away From Home Care® program is included for employees who temporarily reside outside the service area.
Keystone HMO plans
HMO plans are designed to help your employees save money. A participating PCP coordinates all of their care and provides referrals for services with in-network specialists. Out-of-network providers are covered only for emergency services. Emergency and urgent care access is also available outside the U.S., as well as our Away From Home Care® program for employees who temporarily reside outside the service area.
Keystone HMO Proactive plans
Our Keystone HMO Proactive health plans are a popular choice for small employers because they give members access to the full Keystone HMO network at a lower premium. Keystone HMO Proactive plans work just like a typical HMO and use a tiered provider network — providers are grouped into three tiers based on cost and quality measures. Members choose a PCP to coordinate their care and refer them to specialists. They pay the lowest out-of-pocket costs by using doctors and hospitals in Tier 1 – Preferred. More than 50 percent of doctors and hospitals in our network are in the lowest-cost tier.
Certain services, including preventive care, urgent care, and prescription drugs, are not tiered and have the same cost-share. Emergency and urgent care access is also available outside the U.S., as well as our Away From Home Care® program for employees who temporarily reside outside of the service area.
High-deductible health plans (HDHPs)
HDHPs offer members the flexibility of a PPO with lower monthly premiums but higher deductibles. Choose from two fully integrated spending account options — either a BlueSaver® Health Savings Account (HSA) through our preferred vendor, or a BlueSaver® Health Reimbursement Account (HRA). Both offer you easy, integrated account maintenance and online reporting, convenient funding methods, and reduced federal, state, and FICA tax liability.
Prescription drug benefits
Every Blue Solutions health plan includes prescription drug coverage, so your employees have easy and affordable access to covered medications. Our services are cost-effective and comprehensive because medical and pharmacy benefits are integrated. This helps us to better manage overall costs, improve health outcomes, and deliver a better member experience. It also offers your employees more complete care management support and a streamlined experience — one member ID card, one secure member portal, and one source of direct messaging that addresses all their medical and pharmacy needs together. Plus, you get the capabilities and negotiating power of a top-tier pharmacy benefits manager (PBM).
We’ve implemented strategies that help members access medications through our prescription drug benefits4 while keeping costs low.
- A large participating network of more than 68,000 retail and independent pharmacies nationwide.5
- Low-cost generic6 medications are available. Members can find a list of these medications in the Value formulary at ibx.com.
- Members can use our online and mobile tools, including the Price a Drug tool at ibx.com as well as the IBX mobile app to get the cost of a specific drug and compare savings by choosing a generic equivalent or switching from retail to mail-order.
- Mail-order/home delivery is available for certain maintenance medications with free shipping.
- Formulary management includes drugs based upon medical effectiveness, safety, and value.
- Integrated data application enables better utilization and clinical management — providing an improved and holistic experience for you and your employees.
- Our specialty drug management program provides convenient delivery options and support for members with high-cost conditions. We use several strategies to manage costs and care for members.
- Smart RxAssist cost-share assistance is available to help reduce the costs for members on select specialty drugs by offering $0 cost-share for over 200 specialty drugs covered under the medical benefit.
Vision benefits
Every Blue Solutions health plan includes high-quality, affordable adult and pediatric vision benefits7. Our adult and pediatric vision benefits8 give members access to routine eye care, options for affordable, quality eyewear, and more value-added services. Our vision benefits go beyond access to eye exams and eyewear. Employees have access to:
- National network of more than 160,000 access points
- Low-to-no copay on Davis Vision Exclusive Collection frames or an allowance towards any frame purchase
- Exclusive $50 frame allowance enhancement at Visionworks9
- In-network providers include Pearle Vision10, Target Optical10, and Warby Parker10 for adults
- Safe and convenient online in-network shopping options, including 1800Contacts.com, Glasses.com, Visionworks.com, and Befitting.com
- $0 cost-sharing on evaluations and fittings for non-Collection standard contact lenses at participating providers
- Fixed copays on all lens styles and coatings, including protection against blue-light exposure
- Discounted pricing and financing options on LASIK laser vision correction services
- Free hearing exam, exclusive discounts on hearing aids and supplies, and more from Your Hearing Network11 through Davis Vision
- An interactive frame try-on tool allows members to see what Davis Vision Exclusive Collection frames look like on before purchasing them
- Upgraded inventory of Davis Vision Exclusive Collection catalogue of designer frames offers even more stylish options to choose from
Dental benefits
All Blue Solutions medical plans cover in-network dental benefits for children up to age 19 to help kids develop good oral health. PPO and DHMO12 pediatric dental plans include in-network preventive exams and cleanings covered in full to help children develop good oral health.
For extra coverage, you may have the option to add Independence Blue Cross (IBX) Dental13 benefits for your employees and their families.
1 In addition to the Independence Blue Cross behavioral health network, Magellan Behavioral Health, Inc., an independent company, provides limited network and management services for mental health and substance abuse benefits.
2 Teladoc Health, Inc. is an independent company that provides virtual care, and digital mental health services.
3 Referrals are required for physical/occupational therapy, spinal manipulation, acupuncture, and radiology. For lab work, a member’s primary care physician will provide a requisition form.
4 Our prescription drug plans are administered by an independent pharmacy benefits management (PBM) company.
5 The Preferred Pharmacy network, which includes more than 58,000 retail pharmacies, is included in Silver and Bronze plans and Keystone HMO Proactive plans only.
6 Members with HSA-qualified and HRA plans will need to meet the plan’s deductible first to receive the low-cost generic benefit. For members with the PPO Bronze HSA-0 $8,300/100%, no cost-sharing applies after meeting the plan’s deductible.
7 Adult and pediatric vision benefits are not subject to a deductible.
8 Independence Blue Cross vision benefits are administered by Davis Vision, an independent company.
9 An affiliate of Independence Blue Cross has a financial interest in Visionworks.
10 Pearle Vision, Target, and Warby Parker are in-network for adults only. Pediatric members covered under the medical plan are excluded.
11 Your Hearing Network products and services are made available through your coverage with Davis Vision. Your Hearing Network is not affiliated with Independence Blue Cross, and does not provide Blue Cross or Blue Shield products or services. Your Hearing Network and/or Davis Vision are responsible for these products and services.
12 DHMO pediatric dental plans require the selection of a Primary Dental Office (PDO) from the Plan’s dental Managed Care network.
13 Dominion National, an independent company, assists in the administration of IBX Dental benefits.