Blue - Blue Advantage Security HMO? 200

Texas, 2019

  • Plan Type

    HMO

  • Metal Tier

    Catastrophic

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $7,900

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) $7,900
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 No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge 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 No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx No charge after deductible
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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 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

Health Insurance Tools

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Health Exchange Guides

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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) $7,900
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 No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge 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 No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx No charge after deductible
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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 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