BlueSelect Silver 1456C ($0 Deductible / $0 Virtual Visits / 3 PCP Visits for $0 then $2 / Rewards $$$) – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
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 | EPO |
| Deductible | Success
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| Out-of-pocket max | $950 per person $1,900 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 | 20% coinsurance |
| Hospital stay (facility) | $350 copay per Stay |
| Hospital stay (physician) | $20 copay |
| Outpatient procedure (facility) | $250 copay |
| Outpatient procedure (physician) | $20 copay |
| Physical rehabilitation | $10 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $350 copay |
Pharmacy, Drugs, and Medication
| Generic | $2 copay |
| Brand | $10 copay |
| Non-preferred Brand | 10% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | $60 copay |
| Imaging (CT/PET/MRI) | $2 copay |
| Blood work | $15 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $2 copay |
| Psychiatric hospital stay | $350 copay per Stay |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsfl.com/DocumentLibrary/sbc/2024/1456C.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_FL_7T_CareChoices.pdf |
| Search doctor list | https://providersearch.floridablue.com/visitor/ffm/#/?ffmPlanCode=FFMBSC |
