myBlue Connected Care Silver 24M03-70C ($0 Virtual Visits / $0 Primary Care and Specialist Visits with Select Providers / Rewards $$$) – HMO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$100 per person $100 per person
Out-of-pocket max	$1,800 per person $3,600 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	No charge
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$12 copay
Emergency room	50% coinsurance after deductible
Ambulance	50% coinsurance after deductible
Hospital stay (facility)	50% coinsurance after deductible
Hospital stay (physician)	No charge
Outpatient procedure (facility)	50% coinsurance after deductible
Outpatient procedure (physician)	No charge
Physical rehabilitation	$12 copay

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	No charge
Brand	$25 copay
Non-preferred Brand	50% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	No charge
Imaging (CT/PET/MRI)	No charge
Blood work	No charge

Mental and Psychiatric Health Care

Mental Health outpatient services	No charge
Psychiatric hospital stay	50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.bcbsfl.com/DocumentLibrary/sbc/2024/24M03-70C.pdf
Drug and medication plan formulary	https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_FL_6T_ValueScript.pdf
Search doctor list	https://providersearch.floridablue.com/visitor/ffm/#/?ffmPlanCode=FFMMBI