Blue - Blue Cross® Premier PPO Bronze Extra

Michigan, 2019

  • Plan Type

    PPO

  • Metal Tier

    Expanded Bronze

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $6,650

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) $6,650
Deductible (Family) $13,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 35% Coinsurance after deductible
Non Preferred Brand Rx 45% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,700
Plan Blue Cross® Premier PPO Silver Extra Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Value Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Silver Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,700 Coinsurance Not applicable Out of Pocket $6,700
Plan Blue Cross® Premier PPO Gold Deductible $500 Coinsurance Not applicable Out of Pocket $7,000
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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) $6,650
Deductible (Family) $13,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 35% Coinsurance after deductible
Non Preferred Brand Rx 45% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,700
Plan Blue Cross® Premier PPO Silver Extra Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Value Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Silver Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,700 Coinsurance Not applicable Out of Pocket $6,700
Plan Blue Cross® Premier PPO Gold Deductible $500 Coinsurance Not applicable Out of Pocket $7,000