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Blue - Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan
Georgia, 2017
Plan Type
HMO
Metal Tier
Gold
Out of Pocket Maximum
$4,900
Deductible
$1,150
Call (855) 782-0916 to speak with a licensed agent about a new health plan.
Emergency Room Care: $500 Copay after deductible + 10% Coinsurance after deductible
Cost Sharing Benefits (In Network)
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) | $1,150 |
|---|---|
| Deductible (Family) | $3,450 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $4,900 |
| Out of Pocket Maximum (Family) | $9,800 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | $500 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible + 10% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | $200 Copay after deductible + 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 10% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 10% Coinsurance after deductible |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Available |
| Lower Back Pain | Available |
| Pain Management | Available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $500 Copay after deductible + 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 10% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 10% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 10% Coinsurance after deductible |
| Outpatient Facility | 10% Coinsurance after deductible |
| Outpatient Surgery | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance after deductible |
Other Plans in Georgia
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan BCBSHP Silver Core Pathway Guided Access HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BCBSHP Silver Pathway Guided Access HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Bronze Pathway HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Catastrophic Pathway Guided Access HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BCBSHP Silver Core Pathway HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BCBSHP Silver Core Pathway Guided Access HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BCBSHP Silver Core Pathway Guided Access HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Catastrophic Pathway Guided Access HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan | Deductible $1,150 | Coinsurance Not applicable | Out of Pocket $4,900 |
| Plan BCBSHP Silver Pathway HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Catastrophic Pathway Guided Access HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Pathway Guided Access HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Catastrophic Pathway Guided Access HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan | Deductible $1,150 | Coinsurance Not applicable | Out of Pocket $4,900 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Pathway Guided Access HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Catastrophic Pathway Guided Access HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Core Pathway Guided Access HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan | Deductible $1,150 | Coinsurance Not applicable | Out of Pocket $4,900 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Catastrophic Pathway HMO 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 2000 25 | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Silver Pathway Guided Access HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5200 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Bronze Pathway HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan | Deductible $1,150 | Coinsurance Not applicable | Out of Pocket $4,900 |
| Plan BCBSHP Silver Pathway Guided Access HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 30 for HSA | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Core Pathway Guided Access HMO 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BCBSHP Silver Pathway Guided Access HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver Guided Access, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Gold Guided Access, a Multi-State Plan | Deductible $1,150 | Coinsurance Not applicable | Out of Pocket $4,900 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3000 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 5500 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BCBSHP Bronze Pathway Guided Access HMO 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BCBSHP Silver Pathway Guided Access HMO 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $4,850 |
| Plan BCBSHP Silver Pathway HMO 10 for HSA | Deductible $3,200 | Coinsurance Not applicable | Out of Pocket $5,000 |