Blue Value Silver

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

This plan doesn’t require you to designate a Primary Care Select Physician but doing so allows you to enjoy a discounted copay of $45 when visiting that 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   $3,000 individual; $6,000 family
 Out-of-Pocket Maximum
  $8,150 individual; $16,300 family
 Primary Care Office Visit
  $55 copay. Receive a discount copay of $45 when visiting your designated Primary Care Select physician
 Specialist Office Visit   $70 copay. Receive a discounted copay of $60 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: $500 copay / Higher member cost share: $900 copay
 Emergency Room
  $500 hospital copay; $70 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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