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Blue - Blue Choice Preferred Silver PPO
Illinois, 2017
Plan Type
PPO
Metal Tier
Silver
Out of Pocket Maximum
$7,150
Deductible
$3,500
Emergency Room Care: $400 Copay 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) | $3,500 |
|---|---|
| Deductible (Family) | $7,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,150 |
| Out of Pocket Maximum (Family) | $14,300 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | $400 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 20% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 20% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 20% 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 | Not available |
| Pregnancy | Available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 20% Coinsurance after deductible |
| Outpatient Facility | 20% Coinsurance after deductible |
| Outpatient Surgery | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | Data Not Available |
| Specialty Drugs |
73% Cost Sharing Benefits
Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts
Deductibles and Cost Sharing
| Deductible (Individual) | $3,000 |
|---|---|
| Deductible (Family) | $6,000 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $300 Copay after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
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
| Deductible (Individual) | $700 |
|---|---|
| Deductible (Family) | $1,400 |
| Out of Pocket Maximum (Individual) | $2,000 |
| Out of Pocket Maximum (Family) | $4,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $150 Copay after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
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
| Deductible (Individual) | $250 |
|---|---|
| Deductible (Family) | $500 |
| Out of Pocket Maximum (Individual) | $1,250 |
| Out of Pocket Maximum (Family) | $2,500 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $100 Copay after deductible |
| Inpatient Facility | 5% Coinsurance after deductible |
| Inpatient Physician | 5% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in Illinois
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue FocusCare Gold | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan BlueCare Direct Silver | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Bronze | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan BlueCare Direct Bronze | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan BlueCare Direct Silver | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Bronze | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan BlueCare Direct Gold | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Gold | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue FocusCare Silver | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue FocusCare Bronze | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Gold | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Precision Silver HMO | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan BlueCare Direct Bronze | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Silver | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Bronze HMO | Deductible $7,100 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Cross Blue Shield Premier | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,300 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Precision Silver HMO | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Gold HMO | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Precision Silver HMO | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueCare Direct Gold | Deductible $1,750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Blue FocusCare Silver | Deductible $2,600 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Security PPO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan Blue Choice Preferred Bronze PPO | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Cross Blue Shield Solution | Deductible $3,750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Blue Choice Preferred Silver PPO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Cross Blue Shield Basic | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $7,150 |