CareFirst BlueCross BlueShield Preferred 1500, A Multi-State Plan VA

Plan Information
Company CareFirst BlueCross BlueShield
State VA
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) $1,500 Data Not Available
Deductible (Family) $3,000 Data Not Available
Coinsurance Data Not Available Data Not Available
Out of Pocket Maximum (Individual) $5,500 Data Not Available
Out of Pocket Maximum (Family) $11,000 Data Not Available
Services In Network Out of Network
Primary Care Visit $30 Copay after deductible Data Not Available
Specialist Visit $40 Copay after deductible Data Not Available
In Patient Hospital Services 30% Coinsurance after deductible Data Not Available
Emergency Room Services 30% Coinsurance after deductible Data Not Available
Mental / Behavioral Health Data Not Available Data Not Available
Imaging (CT/PET Scans, MRIs) Data Not Available Data Not Available
Rehabilitative Speech Therapy Data Not Available Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available Data Not Available
Preventative Care $0 Data Not Available
Laboratory Outpatient and Professional Services Data Not Available Data Not Available
X-ray and Diagnostic Imaging Data Not Available Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance 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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $700.00
Deductible (Family) $1,400.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Services In Network Out of Network
Primary Care Physician $30 Copay after deductible
Specialists $40 Copay after deductible
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance 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) $0.00
Deductible (Family) $0.00
Out of Pocket Maximum (Individual) $2,250.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $5
Specialists $20
Emergency Room 30%
Inpatient Facility 30%
Inpatient Physician 30%
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx 30%
Non Preferred Brand Rx 50%
Specialty Drugs 50%

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) $0.00
Deductible (Family) $0.00
Out of Pocket Maximum (Individual) $2,250.0
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $10
Emergency Room 10%
Inpatient Facility 10%
Inpatient Physician 10%
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx 10%
Non Preferred Brand Rx 20%
Specialty Drugs 20%

Other Plans

Other plans that are available in the state.

Plan Name
BlueChoice Gold $0
BlueChoice Gold $1,000
BlueChoice HSA Bronze $4,000
BlueChoice HSA Bronze $6,000
BlueChoice HSA Silver $1,300
BlueChoice Plus Bronze $5,500
BlueChoice Plus Silver $2,500
BlueChoice Silver $2,000
BlueChoice Young Adult $6,350
HealthyBlue Gold $1,500
HealthyBlue Platinum $0
BlueCross BlueShield Preferred 1500, A Multi-State Plan
BlueCross BlueShield Preferred 500, A Multi-State Plan
BluePreferred HSA Bronze $3,500
BluePreferred Platinum $0
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