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
Outpatient Facility 10% coinsurance 50% coinsurance
Outpatient Surgery 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
AZ Blue EverydayHealth PPO 1000 - Statewide Network
AZ Blue EverydayHealth PPO 3000 - Statewide Network
AZ Blue EverydayHealth PPO 4000 - Statewide Network
AZ Blue EverydayHealth PPO 6000 - Statewide Network
AZ Blue Essential PPO 1500 - Statewide Network
AZ Blue Essential PPO 4000 - Statewide Network
AZ Blue Essential PPO 6000 - Statewide Network
AZ Blue Portfolio HSA PPO 1500 - Statewide Network
AZ Blue Portfolio HSA PPO 3500 - Statewide Network
AZ Blue Portfolio HSA PPO 5500 - Statewide Network
AZ Blue Portfolio HSA PPO 6300 - Statewide Network
AZ Blue SimpleHealth PPO - Statewide Network
AZ Blue CopayComplete PPO 25 - Statewide Network
AZ Blue CopayComplete PPO 40 - Statewide Network
AZ Blue EverydayHealth HMO 1000 - Alliance Network
AZ Blue EverydayHealth HMO 3000 - Alliance Network
AZ Blue EverydayHealth HMO 4000 - Alliance Network
AZ Blue EverydayHealth HMO 6000 - Alliance Network
AZ Blue EverydayHealth HMO 1000 - Select Network
AZ Blue EverydayHealth HMO 3000 - Select Network
AZ Blue EverydayHealth HMO 4000 - Select Network
AZ Blue EverydayHealth HMO 6000 - Select Network
AZ Blue EverydayHealth HMO 1000 - Secure Network
AZ Blue EverydayHealth HMO 3000 - Secure Network
AZ Blue EverydayHealth HMO 4000 - Secure Network
AZ Blue EverydayHealth HMO 6000 - Secure Network
AZ Blue Essential HMO 1500 - Alliance Network
AZ Blue Essential HMO 4000 - Alliance Network
AZ Blue Essential HMO 6000 - Alliance Network
AZ Blue Essential HMO 1500 - Select Network
AZ Blue Essential HMO 4000 - Select Network
AZ Blue Essential HMO 6000 - Select Network
AZ Blue Essential HMO 1500 - Secure Network
AZ Blue Essential HMO 4000 - Secure Network
AZ Blue Essential HMO 6000 - Secure Network
AZ Blue Portfolio HSA HMO 1500 - Alliance Network
AZ Blue Portfolio HSA HMO 3500 - Alliance Network
AZ Blue Portfolio HSA HMO 5500 - Alliance Network
AZ Blue Portfolio HSA HMO 6300 - Alliance Network
AZ Blue Portfolio HSA HMO 1500 - Select Network
AZ Blue Portfolio HSA HMO 3500 - Select Network
AZ Blue Portfolio HSA HMO 5500 - Select Network
AZ Blue Portfolio HSA HMO 6300 - Select Network
AZ Blue Portfolio HSA HMO 1500 - Secure Network
AZ Blue Portfolio HSA HMO 3500 - Secure Network
AZ Blue Portfolio HSA HMO 5500 - Secure Network
AZ Blue Portfolio HSA HMO 6300 - Secure Network
AZ Blue SimpleHealth HMO - Alliance Network
AZ Blue SimpleHealth HMO - Select Network
AZ Blue SimpleHealth HMO - Secure Network
AZ Blue CopayComplete HMO 25 - Alliance Network
AZ Blue CopayComplete HMO 40 - Alliance Network
AZ Blue CopayComplete HMO 25 - Select Network
AZ Blue CopayComplete HMO 40 - Select Network
AZ Blue CopayComplete HMO 25 - Secure Network
AZ Blue CopayComplete HMO 40 - Secure Network
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