Blue Cross Select Silver

Consider a Silver plan if you want lower monthly premiums and you use healthcare services every so often.

This plan requires you to designate a Primary Care Select Physician, and you will only pay a $40 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   $3,250 individual; $6,500 family
 Out-of-Pocket Maximum
  $8,150 individual; $16,300 family
 Primary Care Office Visit
  $40 copay. Each member must designate a Primary Care Select physician
 Specialist Office Visit   $65 copay. Must be referred to a specialist by your designated Primary Care Select physician
 Telephone and Online Video Consultations   You pay $45 per consultation 
 Outpatient Surgery
  Lower member cost share: $600 copay / Higher member cost share: $1,000 copay
 Emergency Room
  $600 hospital copay; $65 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: $20 copay / Tier 2: $30 copay / Tier 3: $85 copay / Tier 4: 50% member coinsurance / Tier 5 (preferred specialty): $250 copay / Tier 6  (nonpreferred specialty): 30% 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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