BlueDirect Gold 90 – PPO
Network type: PPO
Coverage tier: Gold
Primary care visit: 10% coinsurance after deductible
Specialist visit: 10% coinsurance after deductible
Urgent care visit: 10% coinsurance after deductible
Description
Health Care Plan Details
Network type | PPO |
Deductible | $2,600 per person $2,600 per person |
Out-of-pocket max | $4,300 per person $8,600 per family |
Metal tier | Gold |
Visit Copay
Primary care visit | 10% coinsurance after deductible |
Specialist visit | 10% coinsurance after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | 10% coinsurance after deductible |
Emergency room | 10% coinsurance after deductible |
Ambulance | 10% coinsurance after deductible |
Hospital stay (facility) | 10% coinsurance after deductible |
Hospital stay (physician) | 10% coinsurance after deductible |
Outpatient procedure (facility) | 10% coinsurance after deductible |
Outpatient procedure (physician) | 10% coinsurance after deductible |
Physical rehabilitation | 10% coinsurance after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 10% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | 10% coinsurance after deductible |
Brand | 10% coinsurance after deductible |
Non-preferred Brand | 10% coinsurance after deductible |
Specialty | 20% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 10% coinsurance after deductible |
Imaging (CT/PET/MRI) | 10% coinsurance after deductible |
Blood work | 10% coinsurance after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 10% coinsurance after deductible |
Psychiatric hospital stay | 10% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://www.bcbsnd.com/content/dam/bcbsnd/documents/plans/2024/individual-metallic/bluedirect/BlueDirectGold90-2600_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 |