BlueSolutions for HSA Direct 4100/8200 WPD – PPO
94% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: 20% coinsurance
Specialist visit: 20% coinsurance
Urgent care visit: 20% coinsurance
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $900 per person $1,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | 20% coinsurance |
| Specialist visit | 20% coinsurance |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 20% coinsurance |
| Emergency room | 20% coinsurance |
| Ambulance | $50 copay |
| Hospital stay (facility) | 20% coinsurance |
| Outpatient procedure (facility) | 20% coinsurance |
| Physical rehabilitation | 20% coinsurance |
Maternitowny and Pregnancy
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $50 copay |
| Non-preferred Brand | $75 copay |
| Specialty | 20% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 20% coinsurance |
| Imaging (CT/PET/MRI) | 20% coinsurance |
| Blood work | 20% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 20% coinsurance |
| Psychiatric hospital stay | 20% coinsurance |
