BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$) – PPO

Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: No charge
Specialist visit: $20 copay
Urgent care visit: $85 copay

SKU: 16842FL0260017 Categories: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Description

Health Care Plan Details

Network type PPO
Deductible $0 per person $0 per person
Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit No charge
Specialist visit $20 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $85 copay
Emergency room $1,000 copay
Ambulance 50% coinsurance
Hospital stay (facility) $3,000 copay per Day
Hospital stay (physician) 50% coinsurance
Outpatient procedure (facility) $1,500 copay
Outpatient procedure (physician) 50% coinsurance
Physical rehabilitation $85 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay $3,000 copay

Pharmacy, Drugs, and Medication

Generic $30 copay
Brand $200 copay
Non-preferred Brand 50% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays $175 copay
Imaging (CT/PET/MRI) $20 copay
Blood work $60 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $50 copay
Psychiatric hospital stay $3,000 copay per Day

Health Plan Provider Information

Health Plan Benefits https://www.bcbsfl.com/DocumentLibrary/sbc/2024/24J01-17.pdf
Drug and medication plan formulary https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_FL_7T_CareChoices.pdf
Search doctor list https://providersearch.floridablue.com/visitor/ffm/#/?ffmPlanCode=FFMBOPT