myBlue Silver 2204C ($0 Deductible / $0 Virtual Visits / $0 PCP Visits / $5 Specialist Visits / $0 Generic Meds / Rewards $$$) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $2 copay
Urgent care visit: $10 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | Success
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| Out-of-pocket max | $2,250 per person $4,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $2 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $10 copay |
| Emergency room | $150 copay |
| Ambulance | 25% coinsurance |
| Hospital stay (facility) | 25% coinsurance |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | 25% coinsurance |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $5 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 25% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | Share |
| Brand | $22 copay |
| Non-preferred Brand | 50% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | $15 copay |
| Imaging (CT/PET/MRI) | $2 copay |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge |
| Psychiatric hospital stay | 25% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsfl.com/DocumentLibrary/sbc/2024/2204C.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_FL_6T_ValueScript.pdf |
| Search doctor list | https://providersearch.floridablue.com/visitor/ffm/#/?ffmPlanCode=FFMMBI |
