Blue Advantage Silver PPO℠ 605 – PPO
87% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $70 copay
Specialist visit: $80 copay
Urgent care visit: $60 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $2,200 per person $4,400 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $70 copay |
| Specialist visit | $80 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $60 copay |
| Emergency room | $850 copay, 40% coinsurance |
| Ambulance | 40% coinsurance |
| Hospital stay (facility) | $400 copay per Stay, 40% coinsurance |
| Hospital stay (physician) | 40% coinsurance |
| Outpatient procedure (facility) | 40% coinsurance |
| Outpatient procedure (physician) | 40% coinsurance |
| Physical rehabilitation | 40% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $400 copay, 40% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $30 copay |
| Brand | 50% coinsurance |
| Non-preferred Brand | 50% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 40% coinsurance |
| Imaging (CT/PET/MRI) | 40% coinsurance |
| Blood work | 40% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 40% coinsurance |
| Psychiatric hospital stay | $400 copay per Stay, 40% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsok.com/sbc/ind/sbc-sp5a21bvpiokp-ok-2024.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_OK_6T_HIM.pdf |
| Search doctor list | https://my.providerfinderonline.com/?ci=ok-blueadvantageppo-retail&corp_code=OK |
