Blue EverydayHealth Bronze (2 Free Visits PCP) – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$8,000 per person $8,000 per person
Out-of-pocket max	$9,300 per person $18,600 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	$95 copay
Specialist visit	$150 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$115 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% coinsurance after deductible

Maternitowny and Pregnancy

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

Pharmacy, Drugs, and Medication

Generic	$3 copay
Brand	$200 copay after deductible
Non-preferred Brand	50% coinsurance after deductible
Specialty	50% coinsurance

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	$150 copay
Psychiatric hospital stay	50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://common.secure.azblue.com/SBC/GetSBC?ProductName=EverydayHealth%20Bronze%20&Deductibles=8000&EffectiveDate=2024/01/01&ContractType=2.pdf
Drug and medication plan formulary	https://www.azblue.com/blueexchangeselect3tierformulary
Search doctor list	https://www.azblue.com/neighborhood