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Blue Cross Blue Shield Clear Cost Silver Plan - Off Exchange
Health Insurance Plan Details (2025 Plan)
by Blue Cross and Blue Shield of New Mexico
Monthly Premium
HMO
$ubsidy
Silver
- Deductible
- $4,800 /yr
- Max Out-of-Pocket
- $8,400 /yr
Details
| Deductible (per individual) | $4,800 /yr |
| Deductible (per family) | $9,600 /yr |
| Max Out-of-Pocket (per individual) | $8,400 /yr |
| Max Out-of-Pocket (per family) | $16,800 /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 | HMO |
| Includes Child Dental? | No |
| Includes Adult Dental? | No |
Out-of-Pocket Costs
| Preventive Care | No Charge |
| Primary Care Visit | $50 Copay |
| Specialist Visit | $100 Copay |
| Emergency Room | $300 Copay with deductible |
| Inpatient Facility | $300 Copay per Stay with deductible |
| Inpatient Physician | $300 Copay with deductible |
| Generic Drugs | $35 Copay |
| Preferred Brand Drugs | $50 Copay |
| Non-preferred Brand Drugs | $250 Copay with deductible |
| Specialty Drugs | $100 Copay |
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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