Blue - Blue Cross® Preferred HMO Gold

Michigan, 2017

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,100

  • Deductible

    $250

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $250
Deductible (Family) $500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit $50 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible + 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services No charge
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 Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient $30 Copay after deductible
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 $4 Copay after deductible
Preferred Brand Rx 25% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Select HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Preferred HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Partnered HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Select HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Select HMO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Preferred HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Select HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Metro Detroit HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Preferred HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Preferred HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Select HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
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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) $250
Deductible (Family) $500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit $50 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible + 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services No charge
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 Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient $30 Copay after deductible
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 $4 Copay after deductible
Preferred Brand Rx 25% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Select HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Preferred HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Partnered HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Select HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Select HMO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Preferred HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Select HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Metro Detroit HMO Bronze Saver HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Preferred HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Partnered HMO Silver Saver Deductible $4,500 Coinsurance Not applicable Out of Pocket $5,500
Plan Blue Cross® Select HMO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Preferred HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Select HMO Silver Deductible $1,650 Coinsurance Not applicable Out of Pocket $6,350
Plan Blue Cross® Partnered HMO Bronze HSA Deductible $5,950 Coinsurance Not applicable Out of Pocket $6,350