Blue Cross Blue Shield Blue Advantage Silver 3500 NC

Plan Information
Company Blue Cross and Blue Shield of North Carolina
State NC
Metal Tier Silver
Plan Type PPO

Cost Sharing Benefits

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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $3,500 $7,000
Deductible (Family) $7,000 $14,000
Coinsurance 30% 60%
Out of Pocket Maximum (Individual) $6,350 $12,700
Out of Pocket Maximum (Family) $12,700 $25,400
Services In Network Out of Network
Primary Care Visit $25 60% coinsurance
Specialist Visit $50 60% coinsurance
In Patient Hospital Services 30% Coinsurance after deductible 60% coinsurance
Emergency Room Services $150 $150 copay
Mental / Behavioral Health $50 copay 60% coinsurance
Imaging (CT/PET Scans, MRIs) 30% coinsurance 60% coinsurance
Rehabilitative Speech Therapy $50 copay 60% coinsurance
Rehabilitative Occupational & Physical Therapy $50 copay 60% coinsurance
Preventative Care $0 60% coinsurance
Laboratory Outpatient and Professional Services 30% coinsurance 60% coinsurance
X-ray and Diagnostic Imaging 30% coinsurance 60% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $70 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

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 In Network Out of Network
Deductible (Individual) $3,500.00
Deductible (Family) $7,000.00
Out of Pocket Maximum (Individual) $5,000.00
Out of Pocket Maximum (Family) $10,000.00
Services In Network Out of Network
Primary Care Physician $25
Specialists $50
Emergency Room $150
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $70 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

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) $1,000.00
Deductible (Family) $2,000.00
Out of Pocket Maximum (Individual) $1,900.00
Out of Pocket Maximum (Family) $3,800.00
Services In Network Out of Network
Primary Care Physician $5
Specialists $10
Emergency Room $150
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $70 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

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) $700.00
Out of Pocket Maximum (Family) $1,400.00
Services In Network Out of Network
Primary Care Physician $5
Specialists $10
Emergency Room $150
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $70 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
Blue Advantage Bronze 2700
Blue Advantage Bronze 5000
Blue Advantage Bronze 5500
Blue Advantage Catastrophic
Blue Advantage Gold 0
Blue Advantage Gold 1000
Blue Advantage Platinum 500
Blue Advantage Silver 0
Blue Advantage Silver 2800
Blue Advantage Silver 3000
Blue Advantage Silver 3500
Blue Advantage Silver 5000
Blue Select Gold 1000
Blue Select Silver 3500
Blue Value Bronze 2700
Blue Value Bronze 5000
Blue Value Bronze 5500
Blue Value Catastrophic
Blue Value Gold 0
Blue Value Gold 1000 Gold POS
Blue Value Gold 1000 Gold PPO
Blue Value Platinum 500 Platinum POS
Blue Value Platinum 500 Platinum PPO
Blue Value Silver 0
Blue Value Silver 2800 Silver POS
Blue Value Silver 2800 Silver PPO
Blue Value Silver 3000
Blue Value Silver 3500 Silver POS
Blue Value Silver 3500 Silver PPO
Blue Value Silver 5000 Silver POS
Blue Value Silver 5000 Silver PPO
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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.