Blue - Blue Cross Blue Shield Solution

Texas, 2017

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,500

  • Deductible

    $3,750

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) $3,750
Deductible (Family) $11,250
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,700

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $400 Copay per stay before deductible + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $750 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 $400 Copay per stay before deductible + 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient No charge
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility $300 Copay before deductible + 20% Coinsurance after deductible
Outpatient Surgery $300 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

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,400
Deductible (Family) $10,200
Out of Pocket Maximum (Individual) $4,800
Out of Pocket Maximum (Family) $10,900

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $750 Copay before deductible + 20% Coinsurance after deductible
Inpatient Facility $400 Copay per stay before deductible + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $2,250
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $300 Copay before deductible + 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,800

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% 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 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 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) $3,750
Deductible (Family) $11,250
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,700

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $400 Copay per stay before deductible + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $750 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 $400 Copay per stay before deductible + 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient No charge
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility $300 Copay before deductible + 20% Coinsurance after deductible
Outpatient Surgery $300 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

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,400
Deductible (Family) $10,200
Out of Pocket Maximum (Individual) $4,800
Out of Pocket Maximum (Family) $10,900

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $750 Copay before deductible + 20% Coinsurance after deductible
Inpatient Facility $400 Copay per stay before deductible + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $2,250
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $300 Copay before deductible + 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,800

Doctor Visits

Primary Care Physician 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs 30% 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 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 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