BlueEssentials HD Bronze 5 – EPO
Network type: EPO
Coverage tier: Expanded Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible
Description
Health Care Plan Details
Network type | EPO |
Deductible | $7,500 per person $7,500 per person |
Out-of-pocket max | $7,500 per person $15,000 per family |
Metal tier | Expanded Bronze |
Visit Copay
Primary care visit | No charge after deductible |
Specialist visit | No charge after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | No charge after deductible |
Emergency room | No charge after deductible |
Ambulance | No charge after deductible |
Hospital stay (facility) | No charge after deductible |
Hospital stay (physician) | No charge after deductible |
Outpatient procedure (facility) | No charge after deductible |
Outpatient procedure (physician) | No charge after deductible |
Physical rehabilitation | No charge after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
Generic | No charge after deductible |
Brand | This is the amount you will pay for a generic drug prescription. |
Non-preferred Brand | No charge after deductible |
Specialty | This is the amount you will pay for a generic drug prescription. |
Lab Tests and Diagnostic Procedures
X-rays | No charge after deductible |
Imaging (CT/PET/MRI) | No charge after deductible |
Blood work | No charge after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | No charge after deductible |
Psychiatric hospital stay | No charge after deductible |
Health Plan Provider Information
Health Plan Benefits | https://www.southcarolinablues.com/web/nonsecure/sc/resources/1eebb7d5-e64f-4460-94fe-a8c4787fc82d/BCBS%2520Individual%2520-%2520HD%2520Bronze%25205%25202024.pdf |
Drug and medication plan formulary | https://www.southcarolinablues.com/links/2024/pharmacy/Individual |
Search doctor list | https://www.southcarolinablues.com/links/2024/providers/EPO |