Silver 6100 HD

Plan type:

Details: 
Plan BenefitsIn Network Only
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;
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.

Weight: 
-11