Independent Blue Cross Personal Choice PPO Silver Reserve PA

Plan Information
Company Independence Blue Cross
State PA
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) $3,000 $10,000
Deductible (Family) $6,000 $20,000
Coinsurance $0 50%
Out of Pocket Maximum (Individual) $5,000 $20,000
Out of Pocket Maximum (Family) $10,000 $40,000
Services In Network Out of Network
Primary Care Visit No Charge 50% coinsurance
Specialist Visit No Charge 50% coinsurance
In Patient Hospital Services No Charge 50% coinsurance
Emergency Room Services No Charge $0
Mental / Behavioral Health $0 50% coinsurance
Imaging (CT/PET Scans, MRIs) $0 50% coinsurance
Rehabilitative Speech Therapy $0 50% coinsurance
Rehabilitative Occupational & Physical Therapy $0 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services $0 50% coinsurance
X-ray and Diagnostic Imaging $0 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $30 Copay after deductible
Non Preferred Brand Rx $50 Copay after deductible
Specialty Drugs $35 Copay 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) $2,250.00
Deductible (Family) $4,500.00
Out of Pocket Maximum (Individual) $3,000.00
Out of Pocket Maximum (Family) $6,000.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists No Charge
Emergency Room No Charge
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $30 Copay after deductible
Non Preferred Brand Rx $50 Copay after deductible
Specialty Drugs $35 Copay 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) $750.00
Deductible (Family) $1,500.00
Out of Pocket Maximum (Individual) $1,000.00
Out of Pocket Maximum (Family) $2,000.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists No Charge
Emergency Room No Charge
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay after deductible
Preferred Brand Rx $30 Copay after deductible
Non Preferred Brand Rx $50 Copay after deductible
Specialty Drugs $35 Copay 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) $500.00
Out of Pocket Maximum (Family) $1,000.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists No Charge
Emergency Room No Charge
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge after Deductible
Preferred Brand Rx No Charge after Deductible
Non Preferred Brand Rx No Charge after Deductible
Specialty Drugs No Charge after Deductible

Other Plans

Other plans that are available in the state.

Plan Name
Blue Cross, a Multi-State Plan Gold
Blue Cross, a Multi-State Plan Silver
Keystone HMO Bronze
Keystone HMO Gold
Keystone HMO Gold Proactive
Keystone HMO Platinum
Keystone HMO Silver
Keystone HMO Silver Proactive
Personal Choice Catastrophic
Personal Choice PPO Bronze
Personal Choice PPO Bronze Reserve
Personal Choice PPO Gold
Personal Choice PPO Platinum
Personal Choice PPO Silver
Personal Choice PPO Silver Reserve
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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.