Blue Value Gold

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

This plan does not require you to designate a Primary Care Select Physician but doing so allows you to enjoy a discounted copay of $25 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   $750 individual; $1,500 family
 Out-of-Pocket Maximum
  $6,000 individual; $12,000 family
 Primary Care Office Visit
  $40 copay. Receive a discounted copay of $25 when visiting your designated Primary Care Select physician
 Specialist Office Visit   $60 copay. Receive a discounted copay of $45 when 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: $300 copay / Higher member cost share: $600 copay
 Emergency Room
  $300 facility copay; $60 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: $25 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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