Blue Advantage Plus Silver℠ 605

Health Insurance Plan Details (2024 Plan)

by Blue Cross Blue Shield of Texas

Monthly Premium

POS
$ubsidy
Silver
Deductible
$0 /yr
Max Out-of-Pocket
$9,450 /yr

Details

Deductible (per individual) $0 /yr
Deductible (per family) $0 /yr
Max Out-of-Pocket (per individual) $9,450 /yr
Max Out-of-Pocket (per family) $18,900 /yr
Drug Deductible (per individual) Included in Medical
Drug Deductible (per family) Included in Medical
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type POS
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $115 Copay
Specialist Visit $135 Copay
Emergency Room $950 and 50%
Inpatient Facility $850 Copay per Stay and 50%
Inpatient Physician 50% Coinsurance
Drug Costs
Generic Drugs $40 Copay
Preferred Brand Drugs 50% Coinsurance
Non-preferred Brand Drugs 50% Coinsurance
Specialty Drugs 50% Coinsurance

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List drug list

Insurance Carrier Disclaimer

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

* 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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