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 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? 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 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 |