Blue Cross® Premier PPO Gold – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $30 copay after deductible
Specialist visit: $50 copay after deductible
Urgent care visit: $75 copay
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Blue Cross® Premier PPO Silver – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $30 copay after deductible
Specialist visit: $50 copay after deductible
Urgent care visit: $75 copay -
Blue Cross® Premier PPO Silver Extra – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $80 copay
Urgent care visit: $60 copay -
Blue Cross® Premier PPO Silver Saver HSA – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $30 copay after deductible
Specialist visit: $50 copay after deductible
Urgent care visit: $75 copay after deductible -
Blue Cross® Select HMO Bronze – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $30 copay
Specialist visit: No charge after deductible
Urgent care visit: $40 copay -
Blue Cross® Select HMO Bronze Extra – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $75 copay -
Blue Cross® Select HMO Bronze Saver HSA – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible -
Blue Cross® Select HMO Bronze Secure – HMO
Network type: HMO
Coverage tier: Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible -
Blue Cross® Select HMO Silver – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $50 copay after deductible
Urgent care visit: $40 copay -
Blue Cross® Select HMO Silver Extra – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $80 copay
Urgent care visit: $60 copay -
Blue Cross® Select HMO Silver Saver – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $45 copay
Specialist visit: $90 copay
Urgent care visit: $45 copay -
Blue Dental EPO 80/50/50 – EPO
Network type: EPO
Coverage tier: Low
Basic Dental: 50% after deductible
Major dental care: 50% after deductible
Orthodontics: Not covered
Exams: 20% -
Blue Dental PPO 100/50/50 – PPO
Network type: PPO
Coverage tier: High
Basic Dental: 50% after deductible
Major dental care: 50% after deductible
Orthodontics: Not covered
Exams: No charge -
Blue Dental PPO 80/50/50 – PPO
Network type: PPO
Coverage tier: Low
Basic Dental: 50% after deductible
Major dental care: 50% after deductible
Orthodontics: Not covered
Exams: 20% -
Blue Dental PPO Extra 100/70/50 – PPO
Network type: PPO
Coverage tier: High
Basic Dental: 30%
Major dental care: 50%
Orthodontics: Not covered
Exams: No charge -
Blue Dental PPO Plus 80/60/50 – PPO
Network type: PPO
Coverage tier: Low
Basic Dental: 40% after deductible
Major dental care: 50% after deductible
Orthodontics: Not covered
Exams: 20%