Blue - SimplyBlue 60

North Dakota, 2019

  • Plan Type

    PPO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $6,800

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) $6,800
Deductible (Family) $13,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
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 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in North Dakota

Plan BlueCare 70 Gold Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueDirect 100 Bronze Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan BlueDirect 80 Silver Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,750
Plan BlueEssential 100 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueCare 70 Silver Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueDirect 90 Gold Deductible $2,000 Coinsurance Not applicable Out of Pocket $3,950
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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) $6,800
Deductible (Family) $13,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
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 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in North Dakota

Plan BlueCare 70 Gold Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueDirect 100 Bronze Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan BlueDirect 80 Silver Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,750
Plan BlueEssential 100 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueCare 70 Silver Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan BlueDirect 90 Gold Deductible $2,000 Coinsurance Not applicable Out of Pocket $3,950