Blue POS 80/60 $3400 – POS

Network type: POS
Coverage tier: Silver
Primary care visit: 20% coinsurance after deductible
Specialist visit: 20% coinsurance after deductible
Urgent care visit: 20% coinsurance after deductible

SKU: 19636LA0220014 Categories: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Description

Health Care Plan Details

Network type POS
Deductible $3,400 per person $3,400 per person
Out-of-pocket max $7,900 per person $15,800 per family
Metal tier Silver

Visit Copay

Primary care visit 20% coinsurance after deductible
Specialist visit 20% coinsurance after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care 20% coinsurance after deductible
Emergency room 20% coinsurance after deductible
Ambulance 20% coinsurance after deductible
Hospital stay (facility) 20% coinsurance after deductible
Hospital stay (physician) 20% coinsurance after deductible
Outpatient procedure (facility) 20% coinsurance after deductible
Outpatient procedure (physician) 20% coinsurance after deductible
Physical rehabilitation 20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic 20% coinsurance after deductible
Brand 40% coinsurance after deductible
Non-preferred Brand 40% coinsurance after deductible
Specialty 40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays 20% coinsurance after deductible
Imaging (CT/PET/MRI) 20% coinsurance after deductible
Blood work 20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 20% coinsurance after deductible
Psychiatric hospital stay 20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://www.bcbsla.com/web/applications/sbcportal/sbcs/2024/19636LA0220014-01.pdf
Drug and medication plan formulary http://www.bcbsla.com/pharmacy-2tier-formulary2024
Search doctor list http://www.bcbsla.com/hmopos-medical-vision-dental