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BlueCross - Bronze B07S, Network S
Tennessee, 2017
Plan Type
PPO
Metal Tier
Bronze
Out of Pocket Maximum
$6,400
Deductible
$5,200
Emergency Room Care: 50% Coinsurance after deductible
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) | $5,200 |
|---|---|
| Deductible (Family) | $10,400 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,400 |
| Out of Pocket Maximum (Family) | $12,800 |
Doctor Visits
| Primary Care Visit | 50% Coinsurance after deductible |
|---|---|
| Specialist Visit | 50% Coinsurance after deductible |
| Inpatient Facility | 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
| Emergency Room Services | 50% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 50% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 50% Coinsurance after deductible |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Not available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 50% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 50% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 50% Coinsurance after deductible |
| Outpatient Facility | 50% Coinsurance after deductible |
| Outpatient Surgery | 50% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | 50% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 50% Coinsurance after deductible |
| Non Preferred Brand Rx | 50% Coinsurance after deductible |
| Specialty Drugs | 50% Coinsurance after deductible |
Other Plans in Tennessee
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Silver S01S, Network S | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Gold G06S, Network S | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Silver S04S, Network S | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $5,100 |
| Plan Gold G06S, Network S | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Silver S04S, Network S | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $5,100 |
| Plan Silver S04S, Network S | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $5,100 |
| Plan Bronze B07S, Network S | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,400 |
| Plan Silver S01S, Network S | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Silver S01S, Network S | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Gold G06S, Network S | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Bronze B07S, Network S | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,400 |
| Plan Silver S01S, Network S | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Gold G06S, Network S | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Gold G06S, Network S | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Silver S04S, Network S | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $5,100 |
| Plan Silver S04S, Network S | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $5,100 |
| Plan Bronze B07S, Network S | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,400 |
| Plan Bronze B07S, Network S | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,400 |
| Plan Silver S01S, Network S | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,150 |