Blue - Blue Cross® Premier PPO Gold

Michigan, 2017

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,100

  • Deductible

    $250

Enroll Now
{"state":{"code":"MI","name":"Michigan","fips":26,"exchangeName":["Healthcare.gov"],"exchangeUrl":["http:\/\/www.healthcare.gov"],"exchangeType":["Partnership"]},"year":"2017","plan":{"name":"Blue - Blue Cross\u00ae Premier PPO Gold","planType":"PPO","tier":"Gold","oopm":"5100.00","deductible":"250.00","redirectUrl":"https:\/\/www.healthcare.gov"},"phoneNum":"8558665590"}

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

{"onCurrent":true}

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 $30 Copay after deductible
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 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 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 $15 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® Premier PPO Silver Deductible $1,800 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit EPO Silver Well-Being Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Cross® Premier PPO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit EPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
{"onCurrent":true,"type":"tools"}

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 $30 Copay after deductible
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 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 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 $15 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® Premier PPO Silver Deductible $1,800 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit EPO Silver Well-Being Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Cross® Premier PPO Bronze Extra Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Metro Detroit EPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150