Blue - Blue Value 5500 (limited network, HSA eligible)

North Carolina, 2017

  • Plan Type

    POS

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,550

  • Deductible

    $5,500

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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $0 Copay per stay + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 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 Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient 20% Coinsurance 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 20% Coinsurance after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

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 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 Value 5000 (limited 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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $0 Copay per stay + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 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 Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient 20% Coinsurance 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 20% Coinsurance after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

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 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 Value 5000 (limited 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