Blue Cross myBlueCare (Pennsylvania)

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Company Blue Cross of Northeastern Pennsylvania
Plan Year 2014
State Pennsylvania
Metal Tier Silver
Plan Type PPO
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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) $1,000
Deductible (Family) $2,000
Coinsurance 10%
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctors Visits

Primary Care Visit $15
Specialist Visit $40
In Patient Hospital Services 10% Coinsurance after deductible
Emergency Room Services $100

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $75 copay
Laboratory Outpatient and Professional Services 10% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance

Other

Mental / Behavioral Health 10% coinsurance
Rehabilitative Speech Therapy 10% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance
Outpatient Facility 10% coinsurance
Outpatient Surgery 10% coinsurance

Prescription Drugs

Generic Rx $30
Preferred Brand Rx $90
Non Preferred Brand Rx $150
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) $750.00
Deductible (Family) $1,500.00
Out of Pocket Maximum (Individual) $3,500.00
Out of Pocket Maximum (Family) $7,000.00
Primary Care Physician $15
Specialists $40
Emergency Room $100
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $30.00
Preferred Brand Rx $90
Non Preferred Brand Rx $150
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) $400.00
Deductible (Family) $800.00
Out of Pocket Maximum (Individual) $500.00
Out of Pocket Maximum (Family) $1,000.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $40
Emergency Room $100
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $30.00
Preferred Brand Rx $90
Non Preferred Brand Rx $150
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) $100.00
Deductible (Family) $200.00
Out of Pocket Maximum (Individual) $200.00
Out of Pocket Maximum (Family) $400.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $40
Emergency Room $100
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $30.00
Preferred Brand Rx $90
Non Preferred Brand Rx $150
Specialty Drugs $150

Other Plans

Other plans that are available in the state.

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