Blue - Blue Select 2500 (tiered network)

North Carolina, 2018

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $2,500

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $0 Copay per stay + 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $4 Copay after deductible
Preferred Brand Rx $35 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans in North Carolina

Plan Blue Local 7000 (local network with Duke Health and WakeMed) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 2500 (local network with Duke Health and WakeMed) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value Catastrophic (limited network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 7000 (limited network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 7000 (broad network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 4000 (limited network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value Catastrophic (limited network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 4000 (local network with Duke Health and WakeMed) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 6650 (broad network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Local 2500 (local network with Carolinas HealthCare System) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 7000 (local network with Carolinas HealthCare System) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 4000 (broad network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 7000 (limited network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Select 7000 (tiered network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 2500 (broad network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Select 7000 (tiered network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 2500 (limited network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 6650 (limited network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Value 6650 (limited network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Select 2500 (tiered network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Value 4000 (limited network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Local 4000 (local network with Carolinas HealthCare System) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage Catastrophic (broad network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 2500 (limited network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
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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) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $0 Copay per stay + 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $4 Copay after deductible
Preferred Brand Rx $35 Copay after deductible
Non Preferred Brand Rx $80 Copay after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans in North Carolina

Plan Blue Local 7000 (local network with Duke Health and WakeMed) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 2500 (local network with Duke Health and WakeMed) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value Catastrophic (limited network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 7000 (limited network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 7000 (broad network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 4000 (limited network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value Catastrophic (limited network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 4000 (local network with Duke Health and WakeMed) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 6650 (broad network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Local 2500 (local network with Carolinas HealthCare System) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 7000 (local network with Carolinas HealthCare System) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 4000 (broad network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 7000 (limited network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Select 7000 (tiered network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage 2500 (broad network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Select 7000 (tiered network) Deductible $7,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 2500 (limited network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 6650 (limited network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Value 6650 (limited network, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Select 2500 (tiered network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Value 4000 (limited network) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible) Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Local 4000 (local network with Carolinas HealthCare System) Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Advantage Catastrophic (broad network) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Blue Value 2500 (limited network) Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350