Blue - BlueEssentials Gold 4

South Carolina, 2017

  • Plan Type

    EPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,000

  • Deductible

    $2,200

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) $2,200
Deductible (Family) $4,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $300 Copay before deductible + 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% 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

Other Plans in South Carolina

Plan BlueEssentials Catastrophic 1 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 2 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials HD Silver 6 Deductible $3,800 Coinsurance Not applicable Out of Pocket $3,800
Plan BlueEssentials Silver 9 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,850
Plan BlueEssentials Silver 14 Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 8 Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,700
Plan BlueEssentials HD Silver 13 Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan BlueEssentials HD Silver 5 Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,000
Plan Blue Cross Blue Shield Silver 1, a Multi-State Plan Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Gold 2 Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials Gold 1 Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,500
Plan BlueEssentials Silver 2 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Silver 10 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Bronze 1 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 3 Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 4 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 5 Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 12 Deductible $4,800 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 7 Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Gold 3 Deductible $2,200 Coinsurance Not applicable Out of Pocket $2,200
Plan BlueEssentials HD Bronze 4 Deductible $5,600 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Gold 1, a Multi-State Plan Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan BlueEssentials Silver 3 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan BlueEssentials Silver 11 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 1 Deductible $260 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) $2,200
Deductible (Family) $4,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $300 Copay before deductible + 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% 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

Other Plans in South Carolina

Plan BlueEssentials Catastrophic 1 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 2 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials HD Silver 6 Deductible $3,800 Coinsurance Not applicable Out of Pocket $3,800
Plan BlueEssentials Silver 9 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,850
Plan BlueEssentials Silver 14 Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 8 Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,700
Plan BlueEssentials HD Silver 13 Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan BlueEssentials HD Silver 5 Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,000
Plan Blue Cross Blue Shield Silver 1, a Multi-State Plan Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Gold 2 Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials Gold 1 Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,500
Plan BlueEssentials Silver 2 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Silver 10 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Bronze 1 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 3 Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 4 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 5 Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 12 Deductible $4,800 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 7 Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Gold 3 Deductible $2,200 Coinsurance Not applicable Out of Pocket $2,200
Plan BlueEssentials HD Bronze 4 Deductible $5,600 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Gold 1, a Multi-State Plan Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan BlueEssentials Silver 3 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan BlueEssentials Silver 11 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 1 Deductible $260 Coinsurance Not applicable Out of Pocket $7,150