Blue Advantage Silver Choice | $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | Nationwide Doctors (CSR 94%) – PPO
94% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $4 copay
Specialist visit: $25 copay
Urgent care visit: $25 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | Success
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| Out-of-pocket max | $1,025 per person $2,050 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $4 copay |
| Specialist visit | $25 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $25 copay |
| Emergency room | 40% coinsurance |
| Ambulance | 40% coinsurance |
| Hospital stay (facility) | 40% coinsurance |
| Hospital stay (physician) | 40% coinsurance |
| Outpatient procedure (facility) | 40% coinsurance |
| Outpatient procedure (physician) | 40% coinsurance |
| Physical rehabilitation | $25 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 40% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $4 copay |
| Brand | $20 copay |
| Non-preferred Brand | $80 copay |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 40% coinsurance |
| Imaging (CT/PET/MRI) | 40% coinsurance |
| Blood work | 40% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $4 copay |
| Psychiatric hospital stay | 40% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Choice_0_Ded_CSR94_2024.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_NC_5T_HealthInsuranceMarketplace.pdf |
| Search doctor list | https://healthnav.bcbsnc.com/?ci=COMMERCIAL&network_id=3 |
