Blue is now Bronze.

It's Open Enrollment Time!

Check out our 2021 Bronze plans. We offer a variety of Blue Option Bronze plans for individuals and their families. You'll find summaries of each plan by clicking on the plan names. While there are several different health plans for you to choose from, each Blue Option Bronze plan includes the same basic vision and preventive dental benefits.

 

 

 

Plan List

Bronze 5550

Plan BenefitsIn 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;
Tier 2: 35% after deductible retail/35% after deductible mail order;
Tier 3: 35% after deductible retail/35% after deductible mail order;
Tier 4: 35% after deductible retail/35% after deductible mail order

Specialty Pharmaceuticals

Tier 5: 35% after deductible retail/35% after deductible mail order;
Tier 6: 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 BenefitsIn 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;
Tier 2: deductible retail/deductible mail order;
Tier 3: deductible retail/deductible mail order;
Tier 4: deductible retail/deductible mail order

Specialty Pharmaceuticals

Tier 5: deductible retail/deductible mail order;
Tier 6: 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 BenefitsIn Network Only
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;
Tier 2: $40 retail/$80 mail order;
Tier 3: 20% after deductible retail/20% after deductible mail order;
Tier 4: 20% after deductible retail/20% after deductible mail order

Specialty Pharmaceuticals

Tier 5: 20% after deductible retail/20% after deductible mail order;
Tier 6: 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 BenefitsIn 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;
Tier 2: $40 retail/$80 mail order;
Tier 3: 50% after deductible retail/50% after deductible mail order;
Tier 4: 50% after deductible retail/50% after deductible mail order

Specialty Pharmaceuticals

Tier 5: 50% after deductible retail/50% after deductible mail order;
Tier 6: 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 BenefitsIn 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;
Tier 2: $40 retail/$80 mail order;
Tier 3: Deductible retail/Deductible mail order;
Tier 4: Deductible retail/Deductible mail order

Specialty Pharmaceuticals

Tier 5: Deductible retail/Deductible mail order;
Tier 6: $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.