Blue Cross Blue Shield BlueSolutions for HSA Direct 2600/5200 (Rhode Island)

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Company Blue Cross Blue Shield of Rhode Island
Plan Year 2014
State Rhode Island
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) $2,600
Deductible (Family) $5,200
Coinsurance 10%
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctors Visits

Primary Care Visit 10% coinsurance
Specialist Visit 10% coinsurance
In Patient Hospital Services 10% coinsurance
Emergency Room Services 10% coinsurance

Tests and Imaging

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


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 $3 copay
Preferred Brand Rx $12 copay
Non Preferred Brand Rx $35 copay
Specialty Drugs 60

Other Plans

Other plans that are available in the state.

Plan Name
VantageBlue Direct 1000/2000 WPD
VantageBlue Direct 3000/6000 WPD
VantageBlue Direct 5800/11600 WPD
VantageBlue Select Gold WPD
VantageBlue SelectRI Direct 500/1000 WPD
VantageBlue SelectRI Direct 3000/6000 WPD
VantageBlue SelectRI Direct 5800/11600 WPD
BasicBlue Direct WPD
BlueSolutions for HSA Direct 1500/3000 WPD
BlueSolutions for HSA Direct 2600/5200 WPD
BlueSolutions for HSA Direct 5000/10000 WPD
BlueSolutions for HSA Direct 2400/4800 WPD

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