Blue Cross Blue Shield Portfolio 1500 AZ

Plan Information
Company Blue Cross Blue Shield of Arizona, Inc.
State AZ
Metal Tier Gold
Plan Type PPO

Cost Sharing Benefits

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,500 $2,000
Deductible (Family) $3,000 $4,000
Coinsurance 10% 50%
Out of Pocket Maximum (Individual) $3,000 $6,000
Out of Pocket Maximum (Family) $6,000 $12,000
Services In Network Out of Network
Primary Care Visit 10% Coinsurance after deductible 50% coinsurance
Specialist Visit 10% Coinsurance after deductible 50% coinsurance
In Patient Hospital Services 10% Coinsurance after deductible 50% coinsurance
Emergency Room Services 10% Coinsurance after deductible 10% coinsurance
Mental / Behavioral Health 10% coinsurance 50% coinsurance
Imaging (CT/PET Scans, MRIs) 10% coinsurance 50% coinsurance
Rehabilitative Speech Therapy 10% coinsurance 50% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services 10% coinsurance 50% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
CopayComplete 20
CopayComplete 40
CopayComplete Alliance (Maricopa) 20
CopayComplete Alliance (Maricopa) 40
CopayComplete Select (Maricopa) 20
CopayComplete Select (Maricopa) 40
Essential 1500
Essential 3000
Essential 4000
Essential 6000
EverydayHealth 1000
EverydayHealth 3000
EverydayHealth 4000
EverydayHealth 6000
EverydayHealth Alliance (Maricopa) 1000
EverydayHealth Alliance (Maricopa) 3000
EverydayHealth Alliance (Maricopa) 4000
EverydayHealth Alliance (Maricopa) 6000
EverydayHealth Select (Maricopa) 1000
EverydayHealth Select (Maricopa) 3000
EverydayHealth Select (Maricopa) 4000
EverydayHealth Select (Maricopa) 6000
FitRewards 1500
FitRewards 3000
FitRewards 4000
FitRewards 6000
Portfolio 1500
Portfolio 2500
Portfolio 3500
Portfolio 5500
SimpleHealth
SimpleHealth (Maricopa) Alliance
SimpleHealth (Maricopa) Select
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.