Blue - Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits

Texas, 2019

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $6,000

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) $6,000
Deductible (Family) $15,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility $850 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 $850 Copay per stay after deductible + 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 $600 Copay after deductible + 40% Coinsurance after deductible
Outpatient Surgery $600 Copay after deductible + 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Texas

Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 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) $6,000
Deductible (Family) $15,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility $850 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 $850 Copay per stay after deductible + 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 $600 Copay after deductible + 40% Coinsurance after deductible
Outpatient Surgery $600 Copay after deductible + 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 35% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Texas

Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Silver HMO? 205 - Two $25 PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 301 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Silver? 202 Deductible $1,100 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 303 Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Gold HMO? 206 - Three $30 PCP Visits Deductible $350 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Bronze? 305 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Security HMO? 200 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Plus Gold? 203 Deductible $750 Coinsurance Not applicable Out of Pocket $7,900
Plan Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900