BlueCare Silver 60 – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $45 copay
Specialist visit: $65 copay
Urgent care visit: $45 copay
Description
Health Care Plan Details
| Network type | PPO |
| Deductible | $3,000 per person $3,000 per person |
| Out-of-pocket max | $9,400 per person $18,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $45 copay |
| Specialist visit | $65 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $45 copay |
| Emergency room | 40% coinsurance after deductible |
| Ambulance | 40% coinsurance after deductible |
| Hospital stay (facility) | 40% coinsurance after deductible |
| Hospital stay (physician) | 40% coinsurance after deductible |
| Outpatient procedure (facility) | 40% coinsurance after deductible |
| Outpatient procedure (physician) | 40% coinsurance after deductible |
| Physical rehabilitation | $45 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 40% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $150 copay |
| Non-preferred Brand | $200 copay |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 40% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 40% coinsurance after deductible |
| Blood work | 40% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $45 copay |
| Psychiatric hospital stay | 40% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsnd.com/content/dam/bcbsnd/documents/plans/2024/individual-metallic/bluecare/BlueCareSilver60-3000_IND_ONX_OFX_20240101_SBC.pdf |
| Drug and medication plan formulary | http://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_ND_6T_HealthInsuranceMarketplace.pdf |
| Search doctor list | https://www.bcbsndportals.com/find-a-doctor/#/home |
