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Blue Protect

Calendar Year Deductible $7,350 individual; $14,700 family
Out-of-Pocket Maximum
$7,350 individual; $14,700 family
Physician Visits $50 for first 3; thereafter 0%, subject to the calendar year deductible
Telephone and Online Video Consultations
You pay $45 per consultation
Outpatient Surgery
Covered at 100%; Subject to the calendar year deductible
Emergency Room Covered at 100%; Subject to the calendar year deductible
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
Prescription Drugs

Tier 1-6: You pay 0% after you meet the calendar year deductible 
Pediatric Routine Dental Cleaning and
Yearly Eye Exam

Routine Dental Cleaning and Yearly Eye Exam: you pay 0% after you meet
the calendar year deductible
Covered at 100%; Subject to the calendar year deductible
Covered at 100%; Subject to the calendar year deductible
Covered at 100%; Subject to the calendar year deductible