Blue - Blue Advantage Plus Bronze

Texas, 2017

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,550

  • 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) $13,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Texas

Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 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) $13,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Texas

Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,800
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Plus Gold Deductible $2,750 Coinsurance Not applicable Out of Pocket $3,500
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Gold HMO Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $6,600 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Plus Bronze Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Advantage Plus Silver Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Advantage Silver HMO Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,750 Coinsurance Not applicable Out of Pocket $3,750
Plan Blue Advantage Security HMO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Bronze HMO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Advantage Silver HMO Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,250 Coinsurance Not applicable Out of Pocket $7,150