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Blue Cross Select Gold

Consider a Gold plan if you have regular prescriptions and use healthcare services often.

This plan requires you to designate a Primary Care Select Physician, and you will only pay a $35 copay when visiting your designated physician. Tax credits through the Affordable Care Act may be available with this plan.

Lower Premium

Lower Deductible

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 Calendar Year Deductible   $850 individual; $1,700 family
 Out-of-Pocket Maximum
  $6,000 individual; $12,000 family
 Primary Care Office Visit
  $35 copay. Each member must designate a Primary Care Select physician
 Specialist Office Visit   $50 copay. You must have a referral your Primary Care Select physician
 Telephone and Online Video Consultations   You pay $35 per consultation 
 Outpatient Surgery
  Lower member cost share: $300 copay / Higher member cost share: $600 copay
 Emergency Room
  $300 hospital copay; $50 doctor copay
Pediatric Routine Dental Cleaning and Yearly Eye Exam   Routine Dental Cleaning: you pay $0; Yearly Eye Exam: you pay 20% after you meet the calendar year deductible
 Prescription Drugs   Tier 1: $10 copay / Tier 2: $20 copay / Tier 3: $45 copay / Tier 4: 40% member coinsurance / Tier 5 (preferred specialty): $175
  copay / Tier 6 (nonpreferred specialty): 20% member coinsurance / Generic drugs are mandatory when available
 Notes   This plan uses the Source+Rx 1.0 Prescription Drug List and the ValueONE Network, which does not include all major retail chains. Check the pharmacy network
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