Florida Blue BlueSelect All Copay 1457 FL

Plan Information
Company Florida Blue (BlueCross BlueShield FL)
State FL
Metal Tier Platinum
Plan Type EPO

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) $0 $500
Deductible (Family) $0 $1,000
Coinsurance $0 50%
Out of Pocket Maximum (Individual) $2,000 $12,500
Out of Pocket Maximum (Family) $4,000 $25,000
Services In Network Out of Network
Primary Care Visit $10 50% coinsurance
Specialist Visit $20 50% coinsurance
In Patient Hospital Services $350 Copay per Day 50% coinsurance
Emergency Room Services $75 $350 copay
Mental / Behavioral Health $75 copay 50% coinsurance
Imaging (CT/PET Scans, MRIs) $150 copay 50% coinsurance
Rehabilitative Speech Therapy $20 copay 50% coinsurance
Rehabilitative Occupational & Physical Therapy $20 copay 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services $0 50% coinsurance
X-ray and Diagnostic Imaging $75 copay 50% coinsurance
Outpatient Facility $250 copay 50% coinsurance
Outpatient Surgery $0 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $10
Preferred Brand Rx $30
Non Preferred Brand Rx $50
Specialty Drugs $150

Other Plans

Other plans that are available in the state.

Plan Name
BlueOptions Everyday Health 1423
BlueOptions Essential (HSA) 1419
BlueOptions Everyday Health 1431
BlueOptions Everyday Health 1418
BlueOptions Everyday Health Premier 1418V
BlueOptions Everyday Health 1416
BlueOptions All Copay 1424
BlueOptions Everyday Health 1410
BlueOptions All Copay 1505
BlueSelect Everyday Health 1456
BlueSelect Essential (HSA) 1452
BlueSelect Everyday Health 1464
BlueSelect Everyday Health 1451
BlueSelect Everyday Health Premier 1451V
BlueSelect Everyday Health 1449
BlueSelect All Copay 1457
BlueSelect Everyday Health 1443
BlueSelect All Copay 1535
BlueCare Everyday Health 1490
BlueCare Essential (HSA) 1486
BlueCare Everyday Health 1498
BlueCare Everyday Health 1485
BlueCare Everyday Health 1483
BlueCare All Copay 1491
BlueCare Everyday Health 1477
BlueCare All Copay 1565
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