Blue Focus Silver POS℠ 206 – POS

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	POS
Deductible	$500 per person $500 per person
Out-of-pocket max	$700 per person $1,400 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	$25 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$25 copay
Emergency room	20% coinsurance after deductible
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	20% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	$10 copay

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	No charge after deductible
Brand	20% coinsurance after deductible
Non-preferred Brand	30% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$10 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.bcbsmt.com/sbc/ind/sbc-so6h31blcimtp-mt-2024.pdf
Drug and medication plan formulary	https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_MT_6T_HIM.pdf
Search doctor list	https://my.providerfinderonline.com/?ci=mt-bluefocuspos-retail&corp_code=MT