Bronze Performance PPO 7100/0/50 + Bronze + PPO – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $50 copay
Specialist visit: $85 copay
Urgent care visit: $100 copay
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Bronze PPO 7450/0/50 + Bronze + PPO – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $50 copay
Specialist visit: $85 copay
Urgent care visit: $100 copay -
Bronze QHDHP PPO 6400/0/50 + Bronze + PPO + HSA Eligible – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $50 copay after deductible
Specialist visit: $85 copay after deductible
Urgent care visit: $100 copay after deductible -
Gold Performance PPO 1800/0/30 + Gold + PPO – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $30 copay
Specialist visit: $50 copay
Urgent care visit: $75 copay -
Gold Performance PPO 2650/0/25 + Gold + PPO – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: $75 copay -
Gold PPO 1800/10/20 + Gold + PPO – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $45 copay
Urgent care visit: $75 copay -
Gold PPO 2400/10/20 + Gold + PPO – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $45 copay
Urgent care visit: $75 copay -
Gold Simple PPO 0/0/25 + Gold + PPO – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: $50 copay -
my Blue Access PPO Bronze 3800 – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $65 copay
Specialist visit: $65 copay
Urgent care visit: $100 copay -
my Blue Access PPO Bronze 3800 + Adult Dental and Vision – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $65 copay
Specialist visit: $65 copay
Urgent care visit: $100 copay -
my Blue Access PPO Bronze 7100 HSA – Custom Drug Benefit – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible -
my Blue Access PPO Bronze 8900 – PPO
Network type: PPO
Coverage tier: Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible -
my Blue Access PPO Gold 0 – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $20 copay
Urgent care visit: $40 copay -
my Blue Access PPO Gold 0 + Adult Dental and Vision – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $20 copay
Urgent care visit: $40 copay -
my Blue Access PPO Gold 1500 – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $35 copay
Specialist visit: $35 copay
Urgent care visit: $70 copay -
my Blue Access PPO Gold 1700 HSA – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: $20 copay after deductible
Specialist visit: $20 copay after deductible
Urgent care visit: $40 copay after deductible