BlueEssentials Bronze 6

Health Insurance Plan Details (2024 Plan)

by Blue Cross and Blue Shield of South Carolina

Monthly Premium

EPO
$ubsidy
Bronze
Deductible
$0 /yr
Max Out-of-Pocket
$8,900 /yr

Details

Deductible (per individual) $0 /yr
Deductible (per family) $0 /yr
Max Out-of-Pocket (per individual) $8,900 /yr
Max Out-of-Pocket (per family) $17,800 /yr
Drug Deductible (per individual) $3,000
Drug Deductible (per family) $6,000
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 $45 Copay
Specialist Visit $90 Copay
Emergency Room $1,600 Copay
Inpatient Facility $2100 Copay per Day
Inpatient Physician $90 Copay
Drug Costs
Generic Drugs $30 Copay
Preferred Brand Drugs $175 Copay
Non-preferred Brand Drugs 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

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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