Compare Plans
Silver Plan
Silver 6850
Plan Benefits | In Network Only |
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Coinsurance | 40% |
Deductible (single/family) | $6,850/$13,700 |
Maximum Out Of Pocket (single/family) | $7,800/$15,600 |
Primary Care Physician Services | $25 copayment per visit |
Doctors Care/Blue CareOnDemand | $25 copayment per visit |
Maternity Care | $60 first visit |
Specialist Visit | $60 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | 40% after deductible |
Outpatient Hospital Services | 40% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Emergency Room | 40% after deductible |
Ambulance | 40% after deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $25 retail/$50 mail order; |
Specialty Pharmaceuticals | Tier 5: $300 retail/$600 mail order; |
Durable Medical Equipment | 40% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 40% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 7350
Plan Benefits | In Network Only |
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Coinsurance | 0% |
Deductible (single/family) | $7,350/$14,700 |
Maximum Out Of Pocket (single/family) | $7,350/$14,700 |
Primary Care Physician Services | $40 copayment per visit |
Doctors Care/Blue CareOnDemand | $40 copayment per visit |
Maternity Care | $80 copayment first visit |
Specialist Visit | $80 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Emergency Room | Deductible |
Ambulance | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $35 retail/$70 mail order; |
Specialty Pharmaceuticals | Tier 5: $300 retail/$600 mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 6250
Plan Benefits | In Network Only |
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Coinsurance | 25% |
Deductible (single/family) | $6,250/$12,500 |
Maximum Out Of Pocket (single/family) | $7,800/$15,600 |
Primary Care Physician Services | $20 copayment per visit |
Doctors Care/Blue CareOnDemand | $20 copayment per visit |
Maternity Care | $55 copayment first visit |
Specialist Visit | $55 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | 25% after deductible |
Outpatient Hospital Services | 25% after deductible |
Emergency Room | 25% after deductible |
Ambulance | 25% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $20 retail/$40 mail order; |
Specialty Pharmaceuticals | Tier 5: $300 retail/$600 mail order; |
Durable Medical Equipment | 25% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 25% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 2000
Plan Benefits | In Network Only |
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Coinsurance | 50% |
Deductible (single/family) | $2,000/$4,000 |
Maximum Out Of Pocket (single/family) | $7,500/$15,000 |
Primary Care Physician Services | $35 copayment per visit |
Doctors Care/Blue CareOnDemand | $35 copayment per visit |
Maternity Care | $75 first visit |
Specialist Visit | $75 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | $400 copayment, then 50% after deductible |
Outpatient Hospital Services | 50% after deductible |
Emergency Room | $400 copayment, then 50% after deductible |
Ambulance | 50% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $20 retail/$40 mail order; |
Specialty Pharmaceuticals | Tier 5: 50% after deductible retail/50% after deductible mail order; |
Durable Medical Equipment | 50% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 50% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 3200
Plan Benefits | In Network Only |
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Coinsurance | 50% |
Deductible (single/family) | $3,200/$6,400 |
Maximum Out Of Pocket (single/family) | $7,900/$15,800 |
Primary Care Physician Services | $35 copayment per visit |
Doctors Care/Blue CareOnDemand | $35 |
Maternity Care | $80 copayment first visit |
Specialist Visit | $80 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | 50% after deductible |
Outpatient Hospital Services | 50% after deductible |
Emergency Room | $400, then 50% after deductible |
Ambulance | 50% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $25 retail/$50 mail order; |
Specialty Pharmaceuticals | Tier 5: $300retail/$600 mail order; |
Durable Medical Equipment | 50% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 50% after deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 3500
Plan Benefits | In Network Only |
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Coinsurance | 40% |
Deductible (single/family) | $3,500/$7,000 |
Maximum Out Of Pocket (single/family) | $8,000/$16,000 |
Primary Care Physician Services | $40 copayment per visit |
Doctors Care/Blue CareOnDemand | $40 copaymenet per visit |
Maternity Care | $80 copayment first visit |
Specialist Visit | $80 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | 40% after deductible |
Outpatient Hospital Services | 40% after deductible |
Emergency Room | $350 copayment, then 40% after deductible |
Ambulance | 40% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $25 retail/$50 mail order; |
Specialty Pharmaceuticals | Tier 5: $300 retail/$600 mail order; |
Durable Medical Equipment | 40% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 40% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 6100 HD
Plan Benefits | In Network Only |
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Coinsurance | 0% |
Deductible (single/family) | $6,100/$12,200 |
Maximum Out Of Pocket (single/family) | $6,100/$12,200 |
Primary Care Physician Services | Deductible |
Doctors Care/Blue CareOnDemand | Deductible |
Maternity Care | Deductible |
Specialist Visit | Deductible |
Urgent Care | Deductible |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | Deductible |
Ambulance | Deductible |
Freestanding Ambulatory Surgical Center | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: Deductible retail/Deductible mail order; |
Specialty Pharmaceuticals | Tier 5: Deductible retail/Deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 5550
Plan Benefits | In Network Only |
---|---|
Coinsurance | 20% |
Deductible (single/family) | $5,550/$11,100 |
Maximum Out Of Pocket (single/family) | $7,350/$14,700 |
Primary Care Physician Services | $45 copayment per visit |
Doctors Care/Blue CareOnDemand | $45 copayment per visit |
Maternity Care | $100 first visit |
Specialist Visit | $100 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | $500 copayment, then 20% after deductible |
Outpatient Hospital Services | 20% after deductible |
Emergency Room | $500 copayment, then 20% after deductible |
Ambulance | 20% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $15 retail/$30 mail order; |
Specialty Pharmaceuticals | Tier 5: 20% after deductible retail/20% after deductible mail order; |
Durable Medical Equipment | 20% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 20% after deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 4300 HD
Plan Benefits | In Network Only |
---|---|
Coinsurance | 0% |
Deductible (single/family) | $4,300/$8,600 |
Maximum Out Of Pocket (single/family) | $4,300/$8,600 |
Primary Care Physician Services | Deductible |
Doctors Care/Blue CareOnDemand | Deductible |
Maternity Care | Deductible |
Specialist Visit | Deductible |
Urgent Care | Deductible |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | Deductible |
Ambulance | Deductible |
Freestanding Ambulatory Surgical Center | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: deductible retail/deductible mail order; |
Specialty Pharmaceuticals | Tier 5: deductible retail/deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Silver 7000
Plan Benefits | In Network Only |
---|---|
Coinsurance | 0% |
Deductible (single/family) | $7,000/$14,000 |
Maximum Out Of Pocket (single/family) | $7,000/$14,000 |
Primary Care Physician Services | $0 copayment per visit |
Doctors Care/Blue CareOnDemand | $0 copayment per visit |
Maternity Care | $50 first visit |
Specialist Visit | $50 copayment per visit |
Urgent Care | $50 copayment per visit |
Inpatient Hospital Services | $500 copayment, then deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | $500 copayment, then deductible |
Ambulance | Deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $25 retail/$50 mail order; |
Specialty Pharmaceuticals | Tier 5: deductible retail/deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Bronze Plan
Bronze 5550
Plan Benefits | In Network Only |
---|---|
Coinsurance | 35% |
Deductible (single/family) | $5,550/$11,100 |
Maximum Out Of Pocket (single/family) | $8,550/$17,100 |
Primary Care Physician Services | $60 |
Doctors Care/Blue CareOnDemand | $60 |
Maternity Care | 35% after deductible |
Specialist Visit | 35% after deductible |
Urgent Care | $75 |
Inpatient Hospital Services | $500 copayment, then 35% after deductible |
Outpatient Hospital Services | 35% after deductible |
Emergency Room | $500 copayment, then 35% after deductible |
Ambulance | 35% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: 35% after deductible retail/35% after deductible mail order; |
Specialty Pharmaceuticals | Tier 5: 35% after deductible retail/35% after deductible mail order; |
Durable Medical Equipment | 35% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 35% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services and we will treat covered transplants the same as any other medical condition. |
Bronze 6900 HD
Plan Benefits | In Network Only |
---|---|
Coinsurance | 0% |
Deductible (single/family) | $6,900/$13,800 |
Maximum Out Of Pocket (single/family) | $6,900/$13,800 |
Primary Care Physician Services | Deductible |
Doctors Care/Blue CareOnDemand | Deductible |
Maternity Care | Deductible |
Specialist Visit | Deductible |
Urgent Care | Deductible |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | Deductible |
Ambulance | Deductible |
Freestanding Ambulatory Surgical Center | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: deductible retail/deductible mail order; |
Specialty Pharmaceuticals | Tier 5: deductible retail/deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services and we will treat covered transplants the same as any other medical condition. |
Bronze 6500
Plan Benefits | In Network Only |
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Coinsurance | 20% |
Deductible (single/family) | $6,500/$13,000 |
Maximum Out Of Pocket (single/family) | $8,550/$17,100 |
Primary Care Physician Services | $60 copayment per visit |
Doctors Care/Blue CareOnDemand | $60 copayment per visit |
Maternity Care | $100 copayment first visit |
Specialist Visit | $100 copayment per visit |
Urgent Care | $75 copayment per visit |
Inpatient Hospital Services | $500 copayment, then 20% after deductible |
Outpatient Hospital Services | $500 copayment, then 20% after deductible |
Emergency Room | $500 copayment, then 20% after deductible |
Ambulance | 20% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $40 retail/$80 mail order; |
Specialty Pharmaceuticals | Tier 5: 20% after deductible retail/20% after deductible mail order; |
Durable Medical Equipment | 20% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 20% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Bronze 7300
Plan Benefits | In Network Only |
---|---|
Coinsurance | 50% |
Deductible (single/family) | $7,300/$14,600 |
Maximum Out Of Pocket (single/family) | $8,550/$17,100 |
Primary Care Physician Services | $65 copayment per visit |
Doctors Care/Blue CareOnDemand | $65 copayment per visit |
Maternity Care | $100 first visit |
Specialist Visit | $100 copayment per visit |
Urgent Care | $75 copayment per visit |
Inpatient Hospital Services | $500 copayment, then 50% after deductible |
Outpatient Hospital Services | $500 copayment, then 50% after deductible |
Emergency Room | $500 copayment, then 50% after deductible |
Ambulance | 50% after deductible |
Freestanding Ambulatory Surgical Center | $200 per visit |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $40 retail/$80 mail order; |
Specialty Pharmaceuticals | Tier 5: 50% after deductible retail/50% after deductible mail order; |
Durable Medical Equipment | 50% after deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | 50% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Bronze 8550
Plan Benefits | In Network Only |
---|---|
Coinsurance | 0% |
Deductible (single/family) | $8,550/$17,100 |
Maximum Out Of Pocket (single/family) | $8,550/$17,100 |
Primary Care Physician Services | $70 copayment per visit |
Doctors Care/Blue CareOnDemand | $70 copayment per visit |
Maternity Care | $100 first visit |
Specialist Visit | $100 copayment per visit |
Urgent Care | $75 copayment per visit |
Freestanding Ambulatory Surgical Center | $200 copayment per visit |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | Deductible |
Ambulance | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: $40 retail/$80 mail order; |
Specialty Pharmaceuticals | Tier 5: Deductible retail/Deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice-participating facility must provide services. |
Catastrophic Plan
Catastrophic
Plan Benefits | In Network Only |
---|---|
Coinsurance | 0% |
Deductible (single/family) | $8,550/$17,100 |
Maximum Out Of Pocket (single/family) | $8,550/$17,100 |
Primary Care Physician Services | $25 for first three visits; deductible thereafter |
Doctors Care/Blue CareOnDemand | $25 for first three visits; deductible thereafter |
Maternity Care | Deductible |
Specialist Visit | Deductible |
Urgent Care | Deductible |
Inpatient Hospital Services | Deductible |
Outpatient Hospital Services | Deductible |
Emergency Room | Deductible |
Ambulance | Deductible |
Freestanding Ambulatory Surgical Center | Deductible |
Mental Health and Substance Abuse | Covered the same as medical benefits. |
Gynecologist Exam (two exams per benefit year) | $0 |
Routine Screening Mammogram | $0 |
Routine Screening Colonoscopy | $0 |
Prescription Drugs | Tier 1: deductible retail/deductible mail order; |
Specialty Pharmaceuticals | Tier 5: deductible retail/deductible mail order; |
Durable Medical Equipment | Deductible |
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation | Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year. |
Transplants | A BlueChoice HealthPlan-participating facility must provide services. |
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