BlueCross - Silver S04S, Network S

Tennessee, 2018

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,000

  • 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) $6,000
Out of Pocket Maximum (Family) $12,000

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 50% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $1,350
Deductible (Family) $2,700
Out of Pocket Maximum (Individual) $4,200
Out of Pocket Maximum (Family) $8,400

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $175
Deductible (Family) $350
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $3,200

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $20
Deductible (Family) $40
Out of Pocket Maximum (Individual) $675
Out of Pocket Maximum (Family) $1,350

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

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

Other Plans in Tennessee

Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
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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) $6,000
Out of Pocket Maximum (Family) $12,000

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 50% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $1,350
Deductible (Family) $2,700
Out of Pocket Maximum (Individual) $4,200
Out of Pocket Maximum (Family) $8,400

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $175
Deductible (Family) $350
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $3,200

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% 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) $20
Deductible (Family) $40
Out of Pocket Maximum (Individual) $675
Out of Pocket Maximum (Family) $1,350

Doctor Visits

Primary Care Physician 50% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

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

Other Plans in Tennessee

Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Gold G06S, Network S Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,100
Plan Silver S04S, Network S Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Silver S01S, Network S Deductible $250 Coinsurance Not applicable Out of Pocket $7,000
Plan Bronze B07S, Network S Deductible $5,650 Coinsurance Not applicable Out of Pocket $6,650