Blue Value Silver – PPO
87% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $40 copay
Urgent care visit: $30 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $400 per person $400 per person |
| Out-of-pocket max | $2,200 per person $4,400 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | $40 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay |
| Emergency room | $375 copay |
| Ambulance | 20% coinsurance after deductible |
| Hospital stay (facility) | 15% coinsurance |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | $375 copay |
| Outpatient procedure (physician) | No charge after deductible |
| Physical rehabilitation | 20% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 15% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $50 copay |
| Non-preferred Brand | 40% coinsurance |
| Specialty | $125 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge |
| Imaging (CT/PET/MRI) | $375 copay |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $40 copay |
| Psychiatric hospital stay | No charge |
Health Plan Provider Information
| Health Plan Benefits | https://www.alabamablue.com/sb/2024vsi-87.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_AL_6T_Source+Rx_1.0.pdf |
| Search doctor list | https://www.bcbsal.org/web/provider-finder |
