Blue - Blue Value 5000 (limited network)

North Carolina, 2017

  • Plan Type

    POS

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $5,000

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) $5,000
Deductible (Family) $10,000
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 $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $600 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx $10 Copay after deductible
Preferred Brand Rx $40 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 25% 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. 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 $600 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% 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) $1,000
Deductible (Family) $2,000
Out of Pocket Maximum (Individual) $2,350
Out of Pocket Maximum (Family) $4,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% 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) $500
Deductible (Family) $1,000
Out of Pocket Maximum (Individual) $800
Out of Pocket Maximum (Family) $1,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in North Carolina

Plan Blue Advantage 5500 (broad network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Local 7150 (local network with Duke Medicine and WakeMed) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 3500 (local network with Duke Medicine and WakeMed) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 7150 (local network with Carolinas HealthCare System) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value Catastrophic (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 7150 (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 3500 (limited network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 5000 (broad network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 5000 (limited network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value Catastrophic (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 7150 (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 1500 (tiered network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Local 1500 (local network with Duke Medicine and WakeMed) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5000 (local network with Duke Medicine and WakeMed) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Catastrophic (broad network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 3500 (local network with Carolinas HealthCare System) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 1500 (limited network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 3500 (limited network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 5500 (limited network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 5500 (limited network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Select 1500 (tiered network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Value 1500 (limited network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 5000 (tiered network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 1500 (broad network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 5000 (tiered network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 3500 (broad network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5000 (local network with Carolinas HealthCare System) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 7150 (broad network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 1500 (local network with Carolinas HealthCare System) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
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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) $5,000
Deductible (Family) $10,000
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 $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $600 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx $10 Copay after deductible
Preferred Brand Rx $40 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 25% 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. 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 $600 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% 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) $1,000
Deductible (Family) $2,000
Out of Pocket Maximum (Individual) $2,350
Out of Pocket Maximum (Family) $4,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% 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) $500
Deductible (Family) $1,000
Out of Pocket Maximum (Individual) $800
Out of Pocket Maximum (Family) $1,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility $0 Copay per stay + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in North Carolina

Plan Blue Advantage 5500 (broad network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Local 7150 (local network with Duke Medicine and WakeMed) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 3500 (local network with Duke Medicine and WakeMed) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 7150 (local network with Carolinas HealthCare System) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value Catastrophic (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 7150 (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 3500 (limited network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 5000 (broad network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 5000 (limited network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value Catastrophic (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 7150 (limited network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 1500 (tiered network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Local 1500 (local network with Duke Medicine and WakeMed) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5000 (local network with Duke Medicine and WakeMed) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Catastrophic (broad network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 3500 (local network with Carolinas HealthCare System) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 1500 (limited network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 3500 (limited network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Value 5500 (limited network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Value 5500 (limited network, HSA eligible) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Select 1500 (tiered network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Value 1500 (limited network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 5000 (tiered network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 1500 (broad network) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Select 5000 (tiered network) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 3500 (broad network) Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 5000 (local network with Carolinas HealthCare System) Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage 7150 (broad network) Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Local 1500 (local network with Carolinas HealthCare System) Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,150