BlueCare Silver 60 LP

Health Insurance Plan Details (2024 Plan)

by Blue Cross Blue Shield of North Dakota

Monthly Premium

PPO
$ubsidy
Silver
Deductible
$2,900 /yr
Max Out-of-Pocket
$9,400 /yr

Details

Deductible (per individual) $2,900 /yr
Deductible (per family) $5,800 /yr
Max Out-of-Pocket (per individual) $9,400 /yr
Max Out-of-Pocket (per family) $18,800 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type PPO
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $45 Copay
Specialist Visit $65 Copay
Emergency Room 40.00% Coinsurance after deductible
Inpatient Facility 40.00% Coinsurance after deductible
Inpatient Physician 40.00% Coinsurance after deductible
Drug Costs
Generic Drugs $20 Copay
Preferred Brand Drugs $150 Copay
Non-preferred Brand Drugs $200 Copay
Specialty Drugs 50.00% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* 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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