More Information
Health Insurance Tools
Health Exchange Guides
- What is a Health Insurance Exchange?
- Understanding the ACA Subsidies
- Cost Sharing Reductions
- Minimum Essential Coverage
- What Is An Insurance Rating Area?
- The Individual Mandate and Penalties
- Inpatient vs Outpatient Care and Coverage
- Copay vs Coinsurance
- Average Cost of Health Insurance
- How Age Affects Your Health Insurance Costs
Visualizations and Data
Other Insurance Research
Blue - Blue Advantage Plus Gold
Texas, 2017
Plan Type
HMO
Metal Tier
Gold
Out of Pocket Maximum
$3,500
Deductible
$2,750
Emergency Room Care: $400 Copay before deductible + 20% 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) | $2,750 |
|---|---|
| Deductible (Family) | $8,250 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $3,500 |
| Out of Pocket Maximum (Family) | $10,500 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | $200 Copay per stay before deductible + 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | $400 Copay before deductible + 20% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 20% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 20% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 20% Coinsurance after deductible |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Available |
| Lower Back Pain | Available |
| Pain Management | Not available |
| Pregnancy | Available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $200 Copay per stay before deductible + 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 | $200 Copay before deductible + 20% Coinsurance after deductible |
| Outpatient Surgery | $200 Copay before deductible + 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | No charge |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | Data Not Available |
| Specialty Drugs | 30% Coinsurance after deductible |
Other Plans in Texas
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| 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 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 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 |