City of Quincy Custom Report of 2021 Carryover Deductible

Report: Deductible/ Coinsurance / Max OOP CARRYOVER REPORT
Report Date: December 31, 2021
Service Date Start: May 1, 2021
Service Date End: December 31, 2021

ORIENTATION:
As a reminder, any Out of Pocket amounts incurred from May 1, 2021 to December 31, 2021 under the prior BCBS City of Quincy self-funded plan are carried forward by the NEW ADMINISTRATOR (COALITION HEALTH) to the NEW FULLY INSURED HEALTH PLAN THAT STARTED ON JANUARY 1, 2022.
That new plan combines a High Deductible at BCBS with a DEDUCTIBLE ERASER BENEFIT.
Bottom Line, services incurred between May 1, 2021 and April 30, 2022 are CREDITED TO A SINGLE COMBINED MAX OUT OF POCKET PER PERSON/FAMILY SHOWN BELOW.

"IN NETWORK" SERVICES ARE CAPPED AS FOLLOWS:
$1,000 Maximum Deductible Per Person
$2,000 Maximum Out of Pocket Per Person
$4,000 Maximum Out of Pocket Per Family

"OUT OF NETWORK" SERVICES ARE CAPPED AS FOLLOWS:
$3,000 Maximum Deductible Per Person
$5,000 Maximum Out of Pocket Per Person
$9,000 Maximum Out of Pocket Per Family

IMPORTANT NOTE:
BCBS DOES NOT KNOW that you have a
1. Deductible Carry Over from 2021 or
2. A Secondary Deductible Eraser Plan.

Only Our Help Desk TRACKS YOUR COMBINED CUMMULATIVE BENEFIT
Direct all questions to Help@CoalitionHealth.com

Coalition Health Has Created a Custom Dynamic Report that Tracks Your Deductible/ Coinsurance / Max OOP CARRYOVER From your BCBS 2021 Claims.
To Access This Report Anytime Simply Click Here and Validate Your Identity

Date of Birth(mm/dd/yyyy)
Last 4 digit of your SSN:

We have presented below the information BCBS reported to us regarding your Accumulation of Out of Pocket From 2021. This BCBS report used the following criteria. This means some newer claims may not be included yet-this report will be updated every 2 weeks as BCBS processes claims after Jan 1, 2022. Email Help@CoalitionHealth.com if you see any discrepancies.

Report: BCBS Deductible/ Coinsurance / Max OOP CARRYOVER REPORT
Report Date: December 31, 2021
Service Date Start: May 1, 2021
Service Date End: December 31, 2021

Based on your 2022 Health Coverage Type of the following persons will be included in your carry-over values from 2021.
We have yellow highlighted items that have already Maxed Out your out of pocket in that category.
Until you reach the maximum OOP Per Person of $ and your Household maximum OOP of $ you will still have the possibility of some additional exposure in the non-highlighted categories.

LEGEND
       = Maxed Out
PLEASE NOTE!
You or a family member have already exceeded their deductible limit last year. That means they have qualified for IMMEDIATE REIMBURSEMENT FOR ANY MEDICAL EXPENSES FROM SERVICES OCCURING IN 2022.
We want to EXPEDITE the pick up of your claims at BCBS and process them immediately but that requires your permission. We will expedite your claims if you elect to authorize BCBS to release directly your claims to our Claim Reimbursement Department. You must self-nominate for this VIP SERVICE.

Please Click SUBMIT To Receive a VIP Invitation Email In the Next 24 Hours

Summation of Household Grid

Calendar Year	Deductible Summation By Year	Coinsurance Summation By Year	OOP Sum Ded Plus Coins Summation By Year

Per Family Member Grid

Calendar Year	First Name	Last Name	Relationship	Deductible	Coinsurance	OOP Sum Ded Plus Coinsurance