Blue - Blue Advantage Silver PPO? 204

Oklahoma, 2019

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $1,500

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) $1,500
Deductible (Family) $4,500
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 50% Coinsurance after deductible
Inpatient Facility $400 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services $950 Copay after deductible + 50% 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 Not available

Other

Mental / Behavioral Health Inpatient $400 Copay per stay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility $300 Copay after deductible + 40% Coinsurance after deductible
Outpatient Surgery $300 Copay after deductible + 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $750
Deductible (Family) $2,250
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician 40% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room $950 Copay after deductible + 50% Coinsurance after deductible
Inpatient Facility $400 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $75
Deductible (Family) $225
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician 30% Coinsurance after deductible
Specialists 40% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 40% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $25
Deductible (Family) $75
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 30% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 30% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Oklahoma

Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
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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) $1,500
Deductible (Family) $4,500
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 50% Coinsurance after deductible
Inpatient Facility $400 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services $950 Copay after deductible + 50% 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 Not available

Other

Mental / Behavioral Health Inpatient $400 Copay per stay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility $300 Copay after deductible + 40% Coinsurance after deductible
Outpatient Surgery $300 Copay after deductible + 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $750
Deductible (Family) $2,250
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician 40% Coinsurance after deductible
Specialists 50% Coinsurance after deductible
Emergency Room $950 Copay after deductible + 50% Coinsurance after deductible
Inpatient Facility $400 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $75
Deductible (Family) $225
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician 30% Coinsurance after deductible
Specialists 40% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 40% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% 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) $25
Deductible (Family) $75
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 30% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 30% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Oklahoma

Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver PPO? 204 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Gold PPO? 205 Deductible $200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold PPO? 309 Deductible $1,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Bronze PPO? 206 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 202 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Preferred Silver PPO? 201 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze PPO? 203 Deductible $3,150 Coinsurance Not applicable Out of Pocket $6,650
Plan Blue Preferred Security PPO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900