Blue Advantage Plus Bronze℠ 707 – POS

Network type: POS
Coverage tier: Expanded Bronze
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $75 copay

Description

Health Care Plan Details

Network type POS
Deductible $7,500 per person $7,500 per person
Out-of-pocket max $9,400 per person $18,800 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit $50 copay
Specialist visit $100 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room 50% coinsurance after deductible
Ambulance 50% coinsurance after deductible
Hospital stay (facility) 50% coinsurance after deductible
Hospital stay (physician) 50% coinsurance after deductible
Outpatient procedure (facility) 50% coinsurance after deductible
Outpatient procedure (physician) 50% coinsurance after deductible
Physical rehabilitation $50 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic $25 copay
Brand $50 copay after deductible
Non-preferred Brand $100 copay after deductible
Specialty $500 copay after deductible

Lab Tests and Diagnostic Procedures

X-rays 50% coinsurance after deductible
Imaging (CT/PET/MRI) 50% coinsurance after deductible
Blood work 50% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services $50 copay
Psychiatric hospital stay 50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://www.bcbstx.com/sbc/ind/sbc-bosa91bavitxp-tx-2024.pdf
Drug and medication plan formulary https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_TX_4T_HIM.pdf
Search doctor list https://my.providerfinderonline.com/?ci=tx-blueadvantage-retail&corp_code=TX