Blue Cross Blue Shield Blue Advantage Silver PPO 003 OK

Plan Information
Company Blue Cross Blue Shield of Oklahoma
State OK
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) $6,000 $12,000
Deductible (Family) $12,700 $25,400
Coinsurance $0 20%
Out of Pocket Maximum (Individual) $6,000 $12,000
Out of Pocket Maximum (Family) $12,700 $25,400
Services In Network Out of Network
Primary Care Visit $30 20% coinsurance
Specialist Visit $50 20% coinsurance
In Patient Hospital Services $250 Copay per Stay 20% coinsurance
Emergency Room Services $500 $0
Mental / Behavioral Health $30 copay 20% coinsurance
Imaging (CT/PET Scans, MRIs) $0 20% coinsurance
Rehabilitative Speech Therapy $0 20% coinsurance
Rehabilitative Occupational & Physical Therapy $0 20% coinsurance
Preventative Care $0 20% coinsurance
Laboratory Outpatient and Professional Services $0 20% coinsurance
X-ray and Diagnostic Imaging $0 20% coinsurance
Outpatient Facility $0 20% coinsurance
Outpatient Surgery $0 20% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
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 In Network Out of Network
Deductible (Individual) $5,000.00
Deductible (Family) $10,400.00
Out of Pocket Maximum (Individual) $5,000.00
Out of Pocket Maximum (Family) $10,400.00
Services In Network Out of Network
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
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) $1,500.00
Deductible (Family) $4,500.00
Out of Pocket Maximum (Individual) $1,500.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

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) $1,500.0
Out of Pocket Maximum (Individual) $500.00
Out of Pocket Maximum (Family) $1,500.00
Services In Network Out of Network
Primary Care Physician $30
Specialists $50
Emergency Room $500
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $50
Non Preferred Brand Rx $100
Specialty Drugs $150

Other Plans

Other plans that are available in the state.

Plan Name
comments powered by Disqus