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BlueSolutions for HSA Direct 6300/12600 WOPDAcu

Blue Cross & Blue Shield of Rhode Island
by Blue Cross & Blue Shield of Rhode Island
2026 health insurance plan
Monthly Premium

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BronzePPOHSA eligible
Deductible · ind / family $6,300 / $12,600
Max out-of-pocket · ind / family $8,050 / $16,100
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Estimated yearly cost

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Coverage details

Deductible · individual $6,300 /yr
Deductible · family $12,600 /yr
Max out-of-pocket · individual $8,050 /yr
Max out-of-pocket · family $16,100 /yr
Includes child dental No
Includes adult dental No

Benefit details and out-of-pocket costs

Doctor visits

Preventive care & screenings No charge
Primary care visit 10.00% Coinsurance after deductible
Specialist visit 10.00% Coinsurance after deductible

Hospital & emergency

Emergency room 10.00% Coinsurance after deductible
Inpatient facility 10.00% Coinsurance after deductible
Inpatient physician 10.00% Coinsurance after deductible

Prescription drugs

Tier 1 · Generic $19 Copay after deductible
Tier 2 · Preferred brand $60 Copay after deductible
Tier 3 · Non-preferred brand $100 Copay after deductible
Tier 4 · Specialty $150 Copay after deductible

Plan documents & tools

* Figures shown are only for in-network medical costs.

** Please check with the insurance company if copay and coinsurance rates are before or after the deductible.

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