BlueEssentials Gold 4

Health Insurance Plan Details (2024 Plan)

by Blue Cross and Blue Shield of South Carolina

Monthly Premium

EPO
$ubsidy
Gold
Deductible
$3,000 /yr
Max Out-of-Pocket
$6,600 /yr

Details

Deductible (per individual) $3,000 /yr
Deductible (per family) $6,000 /yr
Max Out-of-Pocket (per individual) $6,600 /yr
Max Out-of-Pocket (per family) $13,200 /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? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $30 Copay
Specialist Visit $55 Copay
Emergency Room $300 Copay with deductible and 35% Coinsurance after deductible
Inpatient Facility 35% Coinsurance after deductible
Inpatient Physician 35% Coinsurance after deductible
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $40 Copay
Non-preferred Brand Drugs $100 Copay
Specialty Drugs 35% 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


Request a phone call from an agent

Advertisement

Health Insurance Plans

Obamacare Plans

Off-Exchange Plans

Sign Up Help
Quote & Compare

 

 

Get advice from Licensed Insurance Agents


Looking for Other Options?

Short Term Health Insurance Plans

  • Top Insurance Carriers
  • No Enrollment Period Restrictions
  • Choose Your Coverage Level
  • Emergency & Hospital Coverage
Health Plan Radar
Health Plan Radar
Partner

Call for a free quote & benefits review

Find the right short term coverage for your needs.