Blue Cross Blue Shield BlueSolutions for HSA Direct 2600/5200 RI

Plan Information
Company Blue Cross Blue Shield of Rhode Island
State RI
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) $2,600 $5,200
Deductible (Family) $5,200 $10,400
Coinsurance 10% 40%
Out of Pocket Maximum (Individual) $4,000 $6,000
Out of Pocket Maximum (Family) $8,000 $12,000
Services In Network Out of Network
Primary Care Visit 10% coinsurance 40% coinsurance
Specialist Visit 10% coinsurance 40% coinsurance
In Patient Hospital Services 10% coinsurance 40% coinsurance
Emergency Room Services 10% coinsurance 10% coinsurance
Mental / Behavioral Health 10% coinsurance 40% coinsurance
Imaging (CT/PET Scans, MRIs) 10% coinsurance 40% coinsurance
Rehabilitative Speech Therapy 10% coinsurance 40% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance 40% coinsurance
Preventative Care $0 40% coinsurance
Laboratory Outpatient and Professional Services 10% coinsurance 40% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance 40% coinsurance
Outpatient Facility 10% coinsurance 40% coinsurance
Outpatient Surgery 10% coinsurance 40% coinsurance
Prescription Drugs In Network Out of Network
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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