Florida Blue BlueSelect Predictable Cost 1456 (Florida)

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Company Florida Blue (BlueCross BlueShield FL)
Plan Year 2014
State Florida
Metal Tier Silver
Plan Type EPO
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Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

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.

Deductible (Individual) $5,000
Deductible (Family) $10,000
Coinsurance $0
Out of Pocket Maximum (Individual) $6,250
Out of Pocket Maximum (Family) $12,500

Doctors Visits

Primary Care Visit $55
Specialist Visit $75
In Patient Hospital Services No Charge
Emergency Room Services $75

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $350 copay
Laboratory Outpatient and Professional Services $0
X-ray and Diagnostic Imaging $150 copay

Other

Mental / Behavioral Health $75 copay
Rehabilitative Speech Therapy $75 copay
Rehabilitative Occupational & Physical Therapy $75 copay
Outpatient Facility $0
Outpatient Surgery $0

Prescription Drugs

Generic Rx $10
Preferred Brand Rx $60
Non Preferred Brand Rx $100
Specialty Drugs $150

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,000.00
Deductible (Family) $6,000.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Primary Care Physician $45
Specialists $65
Emergency Room $75
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $60
Non Preferred Brand Rx $100
Specialty Drugs $150

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $750.00
Deductible (Family) $1,500.00
Out of Pocket Maximum (Individual) $1,250.00
Out of Pocket Maximum (Family) $2,500.00
Services In Network Out of Network
Primary Care Physician $25
Specialists $50
Emergency Room $75
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $4.00
Preferred Brand Rx $16
Non Preferred Brand Rx $30
Specialty Drugs $75

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $500.00
Deductible (Family) $1,000.0
Out of Pocket Maximum (Individual) $1,250.0
Out of Pocket Maximum (Family) $2,500.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $20
Emergency Room $75
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $4.00
Preferred Brand Rx $10
Non Preferred Brand Rx $30
Specialty Drugs $75

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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