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BlueCross S24E $35 PCP Copay + $0 Virtual Care for Medical & Mental Health
Health Insurance Plan Details (2024 Plan)
by BlueCross BlueShield of Tennessee
Monthly Premium
EPO
$ubsidy
Silver
- Deductible
- $5,450 /yr
- Max Out-of-Pocket
- $8,900 /yr
Details
| Deductible (per individual) | $5,450 /yr |
| Deductible (per family) | $10,900 /yr |
| Max Out-of-Pocket (per individual) | $8,900 /yr |
| Max Out-of-Pocket (per family) | $17,800 /yr |
| Drug Deductible (per individual) | $0 |
| Drug Deductible (per family) | $0 |
| Drug Max Out-of-Pocket (per individual) | Included in Medical |
| Drug Max Out-of-Pocket (per family) | Included in Medical |
| Plan Type | EPO |
| Includes Child Dental? | Yes |
| Includes Adult Dental? | No |
Out-of-Pocket Costs
| Preventive Care | No Charge |
| Primary Care Visit | $35 Copay |
| Specialist Visit | $75 Copay |
| Emergency Room | $750 Copay with deductible and 50% Coinsurance after deductible |
| Inpatient Facility | $2000 Copay per Stay with deductible and 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
| Generic Drugs | $60 Copay |
| Preferred Brand Drugs | $100 Copay |
| Non-preferred Brand Drugs | $250 Copay |
| Specialty Drugs | 50% Coinsurance |
Plan Documents
| Summary of Benefits and Coverage | SBC doc |
| Provider Directory | Doctor lookup |
| Drug Formulary List | drug list |
* Figures shown are only for in-network medical costs
** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible
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