BlueOptions Silver 24J01-03B ($0 Deductible / $0 Virtual Visits / $5 PCP Visits / $0 Labs / Rewards $$$) – PPO

87% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $5 copay
Urgent care visit: $70 copay

SKU: 16842FL026000305 Category:

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type PPO
Deductible Success

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Out-of-pocket max $3,150 per person $6,300 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $5 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $70 copay
Emergency room $675 copay
Ambulance 40% coinsurance
Hospital stay (facility) 40% coinsurance
Hospital stay (physician) No charge
Outpatient procedure (facility) 40% coinsurance
Outpatient procedure (physician) No charge
Physical rehabilitation $70 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 40% coinsurance

Pharmacy, Drugs, and Medication

Generic $25 copay
Brand $47 copay
Non-preferred Brand 40% coinsurance
Specialty 50% coinsurance

Lab Tests and Diagnostic Procedures

X-rays $80 copay
Imaging (CT/PET/MRI) $5 copay
Blood work No charge

Mental and Psychiatric Health Care

Mental Health outpatient services $5 copay
Psychiatric hospital stay No charge

Health Plan Provider Information

Health Plan Benefits https://www.bcbsfl.com/DocumentLibrary/sbc/2024/24J01-03B.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