Blue HSA Gold

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

This plan requires a Health Savings Account and covers most of your eligible in-network expenses at 100% once you meet the calendar-year deductible.

Lower Premium

Lower Deductible

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 Calendar Year Deductible   $1,750 individual; $3,500 family
 Out-of-Pocket Maximum
  $6,000 individual; $12,000 family
 Primary Care Office Visit
  Plan pays 90%; Subject to the deductible
 Specialist Office Visit   Plan pays 90%; Subject to the deductible
 Telephone and Online Video Consultations   You pay $45 per consultation 
 Outpatient Surgery
  Covered at 90%; Subject to calendar year deductible
 Emergency Room
  Covered at 90%; Subject to calendar year deductible
Pediatric Routine Dental Cleaning and Yearly Eye Exam   Routine Dental Cleaning: you pay 0% after you meet the calendar year deductible; Yearly Eye Exam: you pay 10% after you meet the
  calendar year deductible
 Prescription Drugs   Tier 1: You pay 10% after you meet the calendar year deductible / Tier 2: You pay 10% after you meet the calendar year deductible / Tier 3: You pay 10% after you meet the calendar year deductible / Tier 4: You pay 10% after you meet the calendar year deductible / Tier 5 (preferred specialty):
You pay 10% after you meet the calendar year deductible / Tier 6 (nonpreferred specialty): You pay 10% after you meet the calendar year deductible / 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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