Blue is now Silver.

It's Open Enrollment Time! Check out our 2020 Silver plans. We offer a variety of Blue Option Silver 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 Silver plan includes the same basic vision and preventive dental benefits.

 

 

Plan List

Silver 2000

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $20 retail/$40 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.

Silver 3200

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit

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;
Tier 2: $25 retail/$50 mail order;
Tier 3: $50 retail/$100 mail order;
Tier 4: $90 retail/$180 mail order

Specialty Pharmaceuticals

Tier 5: $300retail/$600 mail order;
Tier 6: $300 retail/$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 BenefitsIn Network Only
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

$75 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 as any other medical benefit

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;
Tier 2: $25 retail/$50 mail order;
Tier 3: $70 retail/$140 mail order;
Tier 4: $95 retail/$190 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $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 5550

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $15 retail/$30 mail order;
Tier 3: $35 retail/$70 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.

Silver 2400

Plan BenefitsIn Network Only
Deductible (single/family)

$2,400/$4,8000

Maximum Out Of Pocket (single/family)

$8,150/$16,300

Primary Care Physician Services

$45 copayment per visit

Doctors Care/Blue CareOnDemand

$45

Maternity Care

$85 copayment first visit

Specialist Visit

$85 copayment per visit

Inpatient Hospital Services

50% after deductible

Outpatient Hospital Services

50% after deductible

Urgent Care

$75 copayment per visit

Freestanding Ambulatory Surgical Center

$200 per visit

Emergency Room

$450, then 50% after deductible

Ambulance

50% after deductible

Mental Health and Substance Abuse

Covered as any other medical benefit.

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;
Tier 2: $25 retail/$50 mail order;
Tier 3: $55 retail/$110 mail order;
Tier 4: $85 retail/$170 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $300 retail/$600 mail order

Durable Medical Equipment

50% after deductible

Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation

Deductible, then 50%; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitative per benefit year.

Transplants

A BlueChoice-participating facility must provide services.

Silver 4600 HD

Plan BenefitsIn Network Only
Deductible (single/family)

$4,600/$9,200

Maximum Out Of Pocket (single/family)

$4,600/$9,200

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 as any other medical benefit

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.

Silver 4200 HD

Plan BenefitsIn Network Only
Deductible (single/family)

$4,200/$8,400

Maximum Out Of Pocket (single/family)

$4,200/$8,400

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 as any other medical benefit.

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.

Silver 4500

Plan BenefitsIn Network Only
Deductible (single/family)

$4,500/$9,000

Maximum Out Of Pocket (single/family)

$8,150/$16,300

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

$75 copayment per visit

Inpatient Hospital Services

50% after deductible

Outpatient Hospital Services

50% after deductible

Emergency Room

50% after deductible

Ambulance

50% after deductible

Freestanding Ambulatory Surgical Center

$200 per visit

Mental Health and Substance Abuse

Covered as any other medical benefit

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;
Tier 2: $15 retail/$30 mail order;
Tier 3: $60 retail/$120 mail order;
Tier 4: $90 retail/$180 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $300 retail/$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. We will treat covered transplants the same as any other medical condition.

Silver 5001

Plan BenefitsIn Network Only
Deductible (single/family)

$5,000/$10,000

Maximum Out Of Pocket (single/family)

$7,900/$15,800

Primary Care Physician Services

$30 copayment per visit

Doctors Care/Blue CareOnDemand

$30 copayment per visit

Maternity Care

$60 copayment first visit

Specialist Visit

$60 copayment per visit

Urgent Care

$75 copayment per visit

Inpatient Hospital Services

30% after deductible

Outpatient Hospital Services

30% after deductible

Emergency Room

$400 copayment, 30% after deductible

Ambulance

30% after deductible

Freestanding Ambulatory Surgical Center

$200 per visit

Mental Health and Substance Abuse

Covered as any other medical benefit

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;
Tier 2: $20 retail/$40 mail order;
Tier 3: $40 retail/$80 mail order;
Tier 4: $80 retail/$160 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $300 retail/$600 mail order

Durable Medical Equipment

30% after deductible

Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation

30% 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 5004 HD

Plan BenefitsIn Network Only
Deductible (single/family)

$5,000/$10,000

Maximum Out Of Pocket (single/family)

$5,000/$10,000

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

Freestanding Ambulatory Surgical Center

Deductible

Emergency Room

Deductible

Ambulance

Deductible

Mental Health and Substance Abuse

Covered as any other medical benefit.

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.

Silver 6250

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $20 retail/$40 mail order;
Tier 3: $40 retail/$80 mail order;
Tier 4: $90 retail/$180 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $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 6002

Plan BenefitsIn Network Only
Deductible (single/family)

$6,000/$12,000

Maximum Out Of Pocket (single/family)

$6,000/$12,000

Primary Care Physician Services

$55 copayment per visit

Doctors Care/Blue CareOnDemand

$55 copayment per visit

Maternity Care

$100 copayment first visit

Specialist Visit

$100 copayment per visit

Urgent Care

$75 copayment per visit

Inpatient Hospital Services

Deductible

Outpatient Hospital Services

Deductible

Freestanding Ambulatory Surgical Center

$200 per visit

Emergency Room

$400, then deductible

Ambulance

Deductible

Mental Health and Substance Abuse

Covered as any other medical benefit.

Gynecologist Exam (two exams per benefit year)

$0

Routine Screening Mammogram

$0

Routine Screening Colonoscopy

$0

Prescription Drugs

Tier 1: $30 retail/$60 mail order;
Tier 2: $30 retail/$60 mail order;
Tier 3: $55 retail/$110 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.

Silver 8150

Plan BenefitsIn Network Only
Deductible (single/family)

$8,150/$16,300

Maximum Out Of Pocket (single/family)

$8,150/$16,300

Primary Care Physician Services

$0 copayment per visit

Doctors Care/Blue CareOnDemand

$0

Maternity Care

$50 copayment first visit

Specialist Visit

$50 copayment per visit

Urgent Care

$75 copayment per visit

Inpatient Hospital Services

$500 copayment, then deductible

Outpatient Hospital Services

Deductible, then 25%

Emergency Room

$500 copayment, then deductible

Ambulance

Deductible

Freestanding Ambulatory Surgical Center

$200 per visit

Mental Health and Substance Abuse

Covered as any other medical benefit.

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;
Tier 2: $15 retail/$30 mail order;
Tier 3: $35 retail/$70 mail order;
Tier 4: $75 retail/$150 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $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 6850

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $25 retail/$50 mail order;
Tier 3: $45 retail/$90 mail order;
Tier 4: $80 retail/$160 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $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 BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $35 retail/$70 mail order;
Tier 3: $60 retail/$120 mail order;
Tier 4: $75 retail/$150 mail order

Specialty Pharmaceuticals

Tier 5: $300 retail/$600 mail order;
Tier 6: $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 7000

Plan BenefitsIn Network Only
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

$75 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 as any other medical benefit.

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;
Tier 2: $25 retail/$50 mail order;
Tier 3: $45 retail/ $90 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.