Blue Cross Blue Shield BlueCross Silver S16S TN

Plan Information
Company BlueCross BlueShield of Tennessee
State TN
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) $3,500 $7,000
Deductible (Family) $7,000 $14,000
Coinsurance $0 50%
Out of Pocket Maximum (Individual) $3,500 $10,500
Out of Pocket Maximum (Family) $7,000 $21,000
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 No Charge
Preferred Brand Rx No Charge
Non Preferred Brand Rx No Charge
Specialty Drugs No Charge

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,950.00
Deductible (Family) $5,900.00
Out of Pocket Maximum (Individual) $2,950.00
Out of Pocket Maximum (Family) $5,900.00
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
Preferred Brand Rx No Charge
Non Preferred Brand Rx No Charge
Specialty Drugs No Charge

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) $1,150.00
Deductible (Family) $2,300.00
Out of Pocket Maximum (Individual) $1,150.00
Out of Pocket Maximum (Family) $2,300.00
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
Preferred Brand Rx No Charge
Non Preferred Brand Rx No Charge
Specialty Drugs No Charge

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
Preferred Brand Rx No Charge
Non Preferred Brand Rx No Charge
Specialty Drugs No Charge

Other Plans

Other plans that are available in the state.

Plan Name
BlueCross B04P, a Multi-State Plan
BlueCross Bronze B01E
BlueCross Bronze B01S
BlueCross Bronze B02E
BlueCross Bronze B02S
BlueCross Bronze B03E
BlueCross Bronze B03S
BlueCross Bronze B04E
BlueCross Bronze B04S
BlueCross G08P, a Multi-State Plan
BlueCross G11P, a Multi-State Plan
BlueCross Gold G01E
BlueCross Gold G01S
BlueCross Gold G02E
BlueCross Gold G02S
BlueCross Gold G04E
BlueCross Gold G04S
BlueCross Gold G06E
BlueCross Gold G06S
BlueCross Gold G08E
BlueCross Gold G08S
BlueCross Gold G10E
BlueCross Gold G10S
BlueCross Gold G11E
BlueCross Gold G11S
BlueCross Platinum P01E
BlueCross Platinum P01S
BlueCross Platinum P02E
BlueCross Platinum P02S
BlueCross Platinum P03E
BlueCross Platinum P03S
BlueCross S09P, a Multi-State Plan
BlueCross S11P, a Multi-State Plan
BlueCross S12P, a Multi-State Plan
BlueCross Silver S01E
BlueCross Silver S01S
BlueCross Silver S02E
BlueCross Silver S02S
BlueCross Silver S04E
BlueCross Silver S04S
BlueCross Silver S07E
BlueCross Silver S07S
BlueCross Silver S08E
BlueCross Silver S08S
BlueCross Silver S09E
BlueCross Silver S09S
BlueCross Silver S11E
BlueCross Silver S11S
BlueCross Silver S12E
BlueCross Silver S12S
BlueCross Silver S14E
BlueCross Silver S14S
BlueCross Silver S16E
BlueCross Silver S16S
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