Blue Cross Select Silver – PPO
94% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $25 copay
Urgent care visit: $15 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $850 per person $1,700 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | $25 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $15 copay |
| Emergency room | $150 copay |
| Ambulance | 10% coinsurance |
| Hospital stay (facility) | 10% coinsurance |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $150 copay |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | 10% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 10% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $15 copay |
| Non-preferred Brand | 30% coinsurance |
| Specialty | $150 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge |
| Imaging (CT/PET/MRI) | $150 copay |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | No charge |
Health Plan Provider Information
| Health Plan Benefits | https://www.alabamablue.com/sb/2024css-94.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_AL_6T_Source+Rx_1.0.pdf |
| Search doctor list | https://www.bcbsal.org/web/provider-finder |
