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
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $9,150 per person $9,150 per person |
| Out-of-pocket max | $9,150 per person $18,300 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | No charge after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $40 copay |
| Emergency room | No charge after deductible |
| Ambulance | No charge after deductible |
| Hospital stay (facility) | No charge after deductible |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | No charge after deductible |
| Outpatient procedure (physician) | No charge after deductible |
| Physical rehabilitation | No charge after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
| Generic | $35 copay |
| Brand | No charge after deductible |
| Non-preferred Brand | No charge after deductible |
| Specialty | No charge after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | No charge after deductible |
| Imaging (CT/PET/MRI) | No charge after deductible |
| Blood work | $10 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $30 copay |
| Psychiatric hospital stay | No charge after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsm.com/amslibs/content/dam/public/marketplace/2024-individual/sbc/select-bronze-sbc.pdf |
| Drug and medication plan formulary | https://www.bcbsm.com/2024-select-hmo-druglist |
| Search doctor list | https://www.bcbsm.com/marketplace/select-hmo/ |
