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Annual Enrollment for 2023 Benefits is October 26 – November 15, 2022

2022 BENEFITS
2022 BENEFITS

PPO Medical Plan

The PPO Medical Plan covers in-network preventive care, office visits and hospital emergency room care with no deductible; you pay only a flat-dollar copay for these services—and you pay nothing for in-network preventive care. For most other in-network services, you pay 20% after meeting your annual deductible.

In-Network vs. Out-of-Network Care

In-network providers have negotiated service rates with BCBS. An out-of-network provider may charge more than BCBS is willing to pay. Because of this, the out-of-network deductible is higher than the in-network deductible. Before receiving treatment, check with BCBS to ensure a doctor, lab, hospital, specialist or other provider is in-network:

  • Clean Air & Powertrain team members: Go to BCBSAL
  • Motorparts & Performance Solutions team members: Go to BCBSIL

If you’re not sure which division you’re aligned with contact your local HR team.

Plan Feature In-Network Out-Of-Network

Annual Deductible (embedded)1

Individual: $750 Family: $1,500

Individual: $1,500 Family: $3,000

Annual Out-of-Pocket Maximum (embedded)1

Individual: $4,250 Family: $8,500

Individual: $8,500 Family: $17,000

Preventive Care2

Plan pays 100% of plan-eligible preventive care; no deductible applies

After you meet the deductible:
Plan pays 60%
You pay: 40%

Coinsurance3
(inpatient/outpatient care)

  • Doctor visits, hospitalization, outpatient care
  • Inpatient/outpatient mental health and substance abuse
  • Home health care, rehab, durable medical equipment, skilled nursing care, hospice
  • Urgent care

After you meet the deductible:
Plan pays: 80%

You pay: 20%

After you meet the deductible:
Plan pays: 60%

You pay: 40%

Office Visit Copay

Primary Care Physician: $30

Specialist: $60

After you meet the deductible:
Plan pays: 60%

You pay: 40%

Hospital Emergency Room Care

Plan pays 100% after you pay $150 copay

Plan pays 100% after you pay $150 copay

If claim is submitted by your provider with a non-emergency diagnosis:

Plan pays: 80%

You pay: 20% plus an additional $200 penalty

  1. “Embedded” means if any one individual reaches the individual threshold, that individual progresses to the coinsurance or 100% benefit level regardless of coverage tier.
  2. For specific preventive services and immunization lists covered under your plan, contact your claims administrator (BCBSAL or BCBSIL).
  3. Visit limitations and/or pre-certification may apply to some services.

IMPORTANT NOTE: Until further notice, anyone enrolled in a Tenneco medical plan will not be subject to copayments and deductibles related to the diagnostic testing and treatment for Coronavirus (COVID-19), nor will they be required to get prior authorization for treatment. For additional information, contact Blue Cross Blue Shield of Alabama (BCBSAL) or Blue Cross Blue Shield of Illinois (BCBSIL).

For additional information about Coronavirus and your Tenneco benefits, click here.

Tools at Your Fingertips

Your carrier offers tools and resources available 24/7. Find valuable information, check your coverages, look for network providers, review your Explanation of Benefits (EOB) and much more.

Team members aligned to Clean Air & Powertrain

  • Visit alabamablue.com or call 877-733-4375.
  • Download the BCBSAL app, available in the iTunes App Store or Google Play.

Team members aligned to Motorparts & Performance Solutions

  • Visit bcbsil.com/member or call 800-677-1973.
  • Download the BCBSIL app. Text BCBSILAPP to 33633* or search for BCBSIL in the iTunes App Store or Google Play.

Contacts

Medical

Clean Air & Powertrain
BCBSAL

Motorparts & Performance Solutions
BCBSIL

Prescription Drugs

CVS Caremark