BCBSVT Vermont Preferred Silver 94 Plan – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $35 copay
Urgent care visit: $35 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $1,075 per person $2,150 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | $35 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $35 copay |
| Emergency room | $250 copay |
| Ambulance | $35 copay |
| Hospital stay (facility) | No charge |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | No charge |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $35 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | No charge |
Pharmacy, Drugs, and Medication
| Generic | $5 per script copay |
| Brand | 40% coinsurance |
| Non-preferred Brand | 60% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | $35 copay |
| Imaging (CT/PET/MRI) | No charge |
| Blood work | $35 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge |
| Psychiatric hospital stay | No charge |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/SmkBXN5DsaNds4ZJcqcpyWXe.pdf |
| Drug and medication plan formulary | https://www.bluecrossvt.org/pharmacies-medications |
