[bluecross-header]
Blue Advantage Gold 101:
Key Features:
Deductible – $500
Out of Pocked Max – $,250
Primary Care Provider Visits – $20
Specialist Office Visits – $40
Mental Illness and Substance Abuse Treatment – $20
ER Visit – $500 per occurence copay, then 30%
Urgent Care – $20
In Patient Hospital Care -$300 per occurence copay, then 30%
Out Patient Surgery -$200 per occurence copay, then 50%
Out Patient X-Rays and Diagnostic Imaging – 50%
Out Patient imaging(CT/PET/MRIs) – 50%
HSA Eligible – No
Outpatient Prescription Drugs(preferred pharmacy) – $0/$10/$50/$100/30%
Outpatient Prescription Drugs(Non Preferred Pharmacy) – $5/$15/$60/$110/30%
Blue Advantage Gold 111:
Key Features:
Deductible – $0
Out of Pocked Max – $7,150
Primary Care Provider Visits – $50
Specialist Office Visits – $75
Mental Illness and Substance Abuse Treatment – $50
ER Visit – $750
Urgent Care – $50
In Patient Hospital Care -$1,500
Out Patient Surgery -$500
Out Patient X-Rays and Diagnostic Imaging – $100
Out Patient imaging(CT/PET/MRIs) – $250
HSA Eligible – No
Outpatient Prescription Drugs(preferred pharmacy) – $0/$10/$50/$100/30%
Outpatient Prescription Drugs(Non Preferred Pharmacy) – $5/$15/$60/$110/30%
Blue Advantage Plus Gold 101:
Key Features:
Deductible – $2,750
Out of Pocked Max – $3,500
Primary Care Provider Visits – $10
Specialist Office Visits – $20
Mental Illness and Substance Abuse Treatment – $10
ER Visit – $400 per occurence copay, then 20%
Urgent Care – $10
In Patient Hospital Care -$200 per occurence copay, then 20%
Out Patient Surgery -$200 per occurence copay, then 40%
Out Patient X-Rays and Diagnostic Imaging – 40%
Out Patient imaging(CT/PET/MRIs) – 40%
HSA Eligible – No
Outpatient Prescription Drugs(preferred pharmacy) – $0/$10/$50/$100/30%
Outpatient Prescription Drugs(Non Preferred Pharmacy) – $5/$15/$60/$110/30%
Outpatient Prescription Drugs(Non Preferred Pharmacy) – $5/$15/$60/$110/30%
Recent Comments