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Blue - Blue Value Silver 7000 (limited network with UNC Health Alliance)
North Carolina, 2019
Plan Type
POS
Metal Tier
Silver
Out of Pocket Maximum
$7,900
Deductible
$7,000
Emergency Room Care: $900 Copay after deductible
Cost Sharing Benefits (In Network)
Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.
| Deductible (Individual) | $7,000 |
|---|---|
| Deductible (Family) | $14,000 |
| 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 | $900 Copay 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 | Not available |
| Pain Management | Not 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 | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | 40% Coinsurance after deductible |
| Outpatient Surgery | 40% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | $10 Copay after deductible |
|---|---|
| Preferred Brand Rx | $40 Copay after deductible |
| Non Preferred Brand Rx | $80 Copay after deductible |
| Specialty Drugs | 25% 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) | $4,000 |
|---|---|
| Deductible (Family) | $8,000 |
| Out of Pocket Maximum (Individual) | $6,300 |
| Out of Pocket Maximum (Family) | $12,600 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $600 Copay after deductible |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | $10 Copay after deductible |
|---|---|
| Preferred Brand Rx | $40 Copay after deductible |
| Non Preferred Brand Rx | $80 Copay after deductible |
| Specialty Drugs | 25% 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) | $700 |
|---|---|
| Deductible (Family) | $1,400 |
| Out of Pocket Maximum (Individual) | $2,500 |
| Out of Pocket Maximum (Family) | $5,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $500 Copay after deductible |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
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) | $250 |
|---|---|
| Deductible (Family) | $500 |
| Out of Pocket Maximum (Individual) | $600 |
| Out of Pocket Maximum (Family) | $1,200 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $200 Copay after deductible |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in North Carolina
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Advantage Silver 4000 (broad network) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7900 (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network with UNC Health Alliance) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 6750 (limited network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Bronze 6750 (limited network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Local Catastrophic (local network with Atrium Health) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Gold 2500 (tiered network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Catastrophic (broad network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Catastrophic (limited network with UNC Health Alliance) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Bronze 6750 (local network with Atrium Health, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Silver 4000 (limited network) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 4000 (limited network) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Catastrophic (broad network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Silver 4000 (local network with Atrium Health) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Gold 2500 (tiered network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Gold 2500 (local network with Atrium Health) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network with UNC Health Alliance) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Silver 4000 (broad network) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Silver 7000 (local network with Atrium Health) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Gold 2500 (broad network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Silver 7000 (tiered network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Bronze 7900 (local network with Atrium Health) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Silver 7000 (tiered network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Bronze 7000 (broad network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Silver 7000 (broad network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Bronze 6750 (broad network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Bronze 7900 (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Bronze 7900 (broad network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 6750 (limited network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Bronze 7900 (limited network with UNC Health Alliance) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 6750 (limited network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 6750 (limited network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Advantage Bronze 6750 (broad network, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Silver 4000 (limited network) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 4000 (limited network with UNC Health Alliance) | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7900 (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Local Bronze 7000 (local network with Atrium Health) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Gold 2500 (limited network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Gold 2500 (tiered network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Bronze 7900 (broad network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 6750 (limited network with UNC Health Alliance, HSA eligible) | Deductible $6,750 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7900 (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Bronze 7000 (broad network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Bronze 7900 (limited network) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Value Silver 7000 (limited network) | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Select Gold 2500 (tiered network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Advantage Gold 2500 (broad network) | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |