BlueCross - Gold G06S, Network S

Tennessee, 2017

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $4,500

  • Deductible

    $1,500

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) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 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 Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Tennessee

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 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
Plan Bronze B07S, Network S Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,400
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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) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 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 Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Tennessee

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 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
Plan Bronze B07S, Network S Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,400