Blue Plus Minnesota Value Bronze $7750 Plan 406 – PPO

Network type: PPO
Coverage tier: Bronze
Primary care visit: 40% after deductible
Specialist visit: 40% after deductible
Urgent care visit: 40% after deductible

Description

Health Care Plan Details

Network type PPO
Deductible $7,750 per person $7,750 per person
Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Bronze

Visit Copay

Primary care visit 40% after deductible
Specialist visit 40% after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care 40% after deductible
Emergency room 40% after deductible
Ambulance 40% after deductible
Hospital stay (facility) 40% after deductible
Hospital stay (physician) 40% after deductible
Outpatient procedure (facility) 40% after deductible
Outpatient procedure (physician) 40% after deductible
Physical rehabilitation 40% after deductible

Maternitowny and Pregnancy

Labor, delivery, hospital stay 40% after deductible

Pharmacy, Drugs, and Medication

Generic $20 copay
Brand 40% after deductible
Non-preferred Brand 60% after deductible
Specialty 40% after deductible

Lab Tests and Diagnostic Procedures

X-rays 40% after deductible
Imaging (CT/PET/MRI) 40% after deductible
Blood work 40% after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 40% after deductible
Psychiatric hospital stay 40% after deductible

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/XZxPf98mqaBkqzjZV4ttJ9P5.pdf