Medical

Choose the Medical Plan for you

Taking care of your health is one of the most important things you can do—for yourself and your family. Our medical benefits are designed to provide flexible, reliable coverage that fits your needs at every stage of life.

Boston Children’s offers four Medical Plans through Blue Cross Blue Shield of Massachusetts (BCBSMA):

Blue Basic HMO
Blue Plus HMO
Blue Premium PPO
New! Blue Essentials HDHP + HSA

It’s important to consider all your Medical Plan details when choosing a plan. This goes beyond just premium contributions. Take some time to think about what care you and your family will need throughout the year. It’s important to choose a plan that meets your needs, but you don’t want to pay for coverage that you won’t use. And remember – while each plan offers you different levels of coverage, whichever plan you enroll in you automatically have pharmacy coverage through Caremark.

PLEASE NOTE: If your primary job location is outside of New England, then you are only eligible to enroll in the Blue Premium PPO or Blue Essentials HDHP + HSA plan. If you are a Boston Children’s National employee, see your Benefits Guide (coming soon) on the Forms & Contacts page for your rates.

Blue Basic HMO	This option may fit those who anticipate minimal health services during the year. The Blue Basic HMO has a lower premium cost with a higher deductible.
Blue Plus HMO	This option may fit those who estimate they will use a greater number of health services during the year. The Blue Plus HMO has higher premium costs than the Blue Basic HMO, but with lower deductibles.
Blue Premium PPO	This option has the most expensive premiums but allows the most flexibility as you are able to select providers inside and outside of the BCBSMA network. The in-network deductible is the same as the Blue Plus HMO.
Blue Essentials HDHP + HSA	This option is good for those who anticipate they will only need preventive care and general prescription coverage throughout the year. This plan has the lowest premiums with the highest deductible. To help offset the higher deductible, Boston Children’s will contribute a set amount to your HSA.

All Plans cover preventive health services at 100% with no deductible, copayment or coinsurance if the services are performed within the BCBSMA network.

Find a Provider

To find providers in the BCBSMA network, please click below:

Learn More

Need Help Choosing a Plan? Ask ALEX!

You can use our online tool, Ask ALEX, to help you evaluate your benefit elections. ALEX asks you a series of questions, and then makes personalized recommendations based on your needs.

Use the following links to access Ask ALEX:

Compare Your Coverage

Each of our four Medical Plans have different costs of coverage.

How much care you anticipate that you will need throughout the year can inform what plan you should choose. For example, if you anticipate you won’t need much care outside of preventive care, you may not want to choose the Blue Premium PPO. You can always use your decision support tool, Ask ALEX, to help you decide.

Explore the medical coverage comparison chart below. You can also access the full, comprehensive comparison chart here.

*Prescription drugs count toward the deductible for this plan

This is a summary only; limitations apply to the services described above. Refer to the plan documents for more detailed information.

Get Even More Coverage!

You can supplement your medical coverage for more peace of mind by enrolling in Voluntary Benefits – Accident, Critical Illness, and Hospital Confinement Indemnity insurance.

Learn More

	Blue Basic HMO	Blue Plus HMO	Blue Premium PPO		Blue Essentials HDHP + HSA
	Blue Basic HMO	Blue Plus HMO	In-Network	Out-of-Network	Blue Essentials HDHP + HSA
Annual Deductible	$1,000 individual $2,000 family	$500 individual $1,000 family	$500 individual $1,000 family	$1,000 individual $2,000 family	$2,000 individual $4,000 family*
Annual Out-of-pocket Maximum	$3,000 individual $6,000 family	$2,000 individual $4,000 family	$3,000 individual $6,000 family		$4,000 individual $8,000 family
Boston Children’s contribution to HSA	N/A	N/A	N/A	N/A	$500 Employee Only, $1,000 All other coverage categories
Routine Physical & Preventive Exams	$0	$0	$0	30% after ded.	$0
Non-routine Primary Care Office Telehealth Visits	$25/visit	$25/visit	$25/visit	30% after ded.	20% after ded.
Mental Health Office Visits	$0 first 6 visits; then $25/visit	$0 first 6 visits; then $25/visit	$0 first 6 visits; then $25/visit	30% after ded.	$0 for first 6 visits after ded.; then 20% coinsurance
Physical, Occupational, Speech, Respiratory Therapy	$40/visit	$40/visit	$40/visit	30% after ded.	20% after ded.
Chiropractic Services	$40/visit	$40/visit	$40/visit	30% coinsurance	20% after ded.
Inpatient Medical & Surgical Care (per admission)	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Ambulance Services	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Maternity Services	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Prenatal Care	$0	$0	$0	30% after ded.	$0
Well Newborn Care during maternity admission	$0	$0	$0	30% after ded.	$0
Diagnostic Imaging	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Diagnostic Lab Work	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
High-end Radiology	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Durable Medical Equipment	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Outpatient Day Surgery	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Home Health Care	20% after ded.	10% after ded.	10% after ded.	30% after ded.	20% after ded.
Urgent Care	$40/visit	$40/visit	$40/visit	30% after ded.	20% after ded.
Annual Routine Eye Exam	$0	$0	$0	30% after ded.	$0
Emergency Room	20% after ded.	$150/visit – waived if admitted	$150/visit – waived if admitted		20% after ded.

* Prescription drugs count toward the deductible for this plan. Also, if you see an out-of-network provider, a different (out-of-network) deductible, out-of-pocket maximum, and copayment apply.

This is a summary only; limitations apply to the services described above. Refer to the plan documents for more detailed information.

Medical Bi-Weekly Rates

You and Boston Children’s share in the cost of your Medical premium payment.

The pre-tax amount you contribute per pay period is based on your work status (full-time or part-time), base pay, coverage level, and your choice of plan.

You pay for Medical coverage on a before-tax basis. To make coverage affordable for as many employees as possible, Boston Children’s offers levels of pricing based on pay. Your contribution rate will vary as follows:

Salary Level	If your base hourly rate or 40-hour annualized salary equivalent is:	Boston Children’s Subsidy
Green Salary Level	Hourly Employee: Less than $24.04 per hour; Salaried Employee: Less than $50,000 per year	$$$$
Orange Salary Level	Hourly Employee: $24.05 to $48.07 per hour; Salaried Employee: $50,000 to $99,999 per year	$$$
Blue Salary Level	Hourly Employee: $48.08 to $72.11 per hour; Salaried Employee: $100,000 to $149,999 per year	$$
Purple Salary Level	Hourly Employee: More than $72.11 per hour; Salaried Employee: More than $150,000 per year	$

Note: Salary Tier rates are based on a 40-hour workweek so if you are under 40 hours, you may fall into a different tier.

Keep in mind that for 2026, rates are based on 27 pay periods.

Green Tier

Tier/Hours	Plan Name	Employee Only	Employee + Spouse	Employee + Child(ren)	Family
Green Tier 30+ hrs.	Blue Basic HMO	$11.25	$22.73	$21.37	$32.85
	Blue Plus HMO	$68.11	$137.62	$129.43	$198.92
	Blue Premium PPO	$183.99	$371.64	$349.55	$537.22
	Blue Essentials HDHP + HSA	$5.63	$11.37	$10.68	$16.43
Green Tier 20-29.9 hrs.	Blue Basic HMO	$145.35	$293.60	$276.14	$424.41
	Blue Plus HMO	$202.22	$408.49	$384.22	$590.48
	Blue Premium PPO	$318.08	$642.52	$604.34	$928.79
	Blue Essentials HDHP + HSA	$139.72	$282.24	$265.46	$407.99

Orange Tier

Tier/Hours	Plan Name	Employee Only	Employee + Spouse	Employee + Child(ren)	Family
Orange Tier 30+ hrs.	Blue Basic HMO	$47.56	$96.08	$90.36	$138.88
	Blue Plus HMO	$104.43	$210.96	$198.43	$304.96
	Blue Premium PPO	$220.30	$444.99	$418.55	$643.26
	Blue Essentials HDHP + HSA	$23.78	$48.04	$45.18	$69.44
Orange Tier 20-29.9 hrs.	Blue Basic HMO	$174.82	$353.13	$332.16	$510.48
	Blue Plus HMO	$227.85	$460.27	$432.94	$665.35
	Blue Premium PPO	$335.90	$678.51	$638.19	$980.80
	Blue Essentials HDHP + HSA	$151.04	$305.10	$286.98	$441.04

Blue Tier

Tier/Hours	Plan Name	Employee Only	Employee + Spouse	Employee + Child(ren)	Family
Blue Tier 30+ hrs.	Blue Basic HMO	$66.32	$133.96	$126.00	$193.64
	Blue Plus HMO	$119.35	$241.09	$226.76	$348.51
	Blue Premium PPO	$227.40	$459.30	$432.04	$663.96
	Blue Essentials HDHP + HSA	$33.16	$66.98	$63.00	$96.82
Blue Tier 20-29.9 hrs.	Blue Basic HMO	$182.69	$369.01	$347.08	$533.43
	Blue Plus HMO	$235.71	$476.14	$447.85	$688.29
	Blue Premium PPO	$343.76	$694.38	$653.11	$1,003.75
	Blue Essentials HDHP + HSA	$149.53	$302.04	$284.09	$436.61

Purple Tier

Tier/Hours	Plan Name	Employee Only	Employee + Spouse	Employee + Child(ren)	Family
Purple Tier 30+ hrs.	Blue Basic HMO	$78.29	$158.16	$148.77	$228.64
	Blue Plus HMO	$133.32	$269.33	$253.32	$389.30
	Blue Premium PPO	$245.42	$495.74	$466.30	$716.62
	Blue Essentials HDHP + HSA	$39.15	$79.08	$74.39	$114.32
Purple Tier 20-29.9 hrs.	Blue Basic HMO	$197.68	$399.33	$375.60	$577.25
	Blue Plus HMO	$252.70	$510.48	$480.15	$737.92
	Blue Premium PPO	$364.80	$736.91	$693.12	$1,065.23
	Blue Essentials HDHP + HSA	$158.54	$320.25	$301.22	$462.93

Full-time rates apply to regular employees in a position scheduled for 30 or more hours per week, House Staff and Joint Appointees.

Note: If you are a BCHN or Union employee, you have different bi-weekly rates. Please see your Benefits Guide on the Resources & Contacts page for your full rates.

The Health Savings Account

If you enroll in the Blue Essentials HDHP, you can also enroll in a Health Savings Account (HSA), administered by Fidelity, to help you pay your deductible.

The HSA is an account you own and can contribute to on a pre-tax basis to pay for healthcare expenses now, as well as in the future. In addition to your own contribution, Boston Children’s contributes to your HSA to further help you pay for eligible healthcare expenses including deductibles, prescription drugs, and more. The best part is your account is yours to keep even if you leave Boston Children’s or retire.

Please note: If you enroll in the HDHP with HSA, IRS regulations don’t allow you or your covered spouse to contribute to a full purpose Health Care Flexible Spending Account (FSA) at the same time, in the same plan year; nor can either of you be enrolled in Medicare.

Is the HDHP with HSA right for you?

Use ALEX to help you decide. ALEX asks you a series of questions, and then makes personalized recommendations based on your needs.

Use the following links to access Ask ALEX:

Contribution Limits

Boston Children’s contributions will be deposited at the beginning of the year and available immediately. The chart below shows how contributions can add up relative to IRS limits.

Contributions	Employee Only coverage	Employee + Spouse, Employee + Child(ren), or Family coverage
Boston Children’s Contributions	$500	$1,000
Maximum IRS Limit for 2026 (includes Boston Children’s contributions)	$4,400	$8,750
Catch-up Contributions if Age 55 or older	Additional $1,000	Additional $1,000

Contributions

Employee Only coverage

Employee + Spouse, Employee + Child(ren), or Family coverage

Boston Children’s Contributions

$500

$1,000

Maximum IRS Limit for 2026

(includes Boston Children’s contributions)

$4,400

$8,750

Catch-up Contributions if Age 55 or older

Additional $1,000

Advantages of an HSA

There are a lot of advantages to opening and owning an HSA beyond just the Boston Children’s contribution.

You and Boston Children’s contribute to your HSA, which can be used to pay for eligible health care expenses including copays, deductibles, prescription drugs, dental, vision, and more.
There is a triple tax advantage – money is contributed on a pre-tax basis, interest and earnings on account are not taxed, and account can be used for qualified healthcare expenses tax-free.
You can invest your account in a number of different funds.
Unused money rolls over from year-to-year and is yours to keep, even if you leave or retire from Boston Children’s.
You can elect, change, or end your HSA elections at any time.

Please note: If you enroll in the HDHP with HSA, IRS regulations don’t allow you or your covered spouse to contribute to a Health Care Flexible Spending Account (FSA) at the same time, in the same plan year; in addition, neither of you are permitted to be enrolled a non-HDHP medical plan or in Medicare.

HSA Education Corner

An HSA comes with lots of advantages – and a lot to learn about when first opening one. Boston Children’s partners with Fidelity, your HSA administrator, to make sure you have the resources you need to learn about your High Deductible Health Plan and how to use your HSA.

To find answers to any questions you have, start with this helpful FAQ.

You can visit the Fidelity website at any time to explore their robust resources, or get started with the targeted resources below.

You can also watch this quick video that gives a high level look at how to use your HSA.

We will keep this HSA Education Corner updated with timely information, tools, and resources, so if you’re enrolled in the Blue Essentials HDHP + HSA, make sure to check back here with any questions you may have!

Contact Fidelity

Visit netbenefits.com/BCH or call 855-242-4032.

Fidelity’s Website

Medical

Choose the Medical Plan for you

Boston Children’s offers four Medical Plans through Blue Cross Blue Shield of Massachusetts (BCBSMA):

Find a Provider

Need Help Choosing a Plan? Ask ALEX!

Compare Your Coverage

Get Even More Coverage!

Medical Bi-Weekly Rates

The Health Savings Account

Is the HDHP with HSA right for you?

Contact Fidelity

Medical Plan Resources

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