BlueCross BlueShield PPO

BlueCross BlueShield PPO | Blue Cross Premier Gold

  • Blue Cross Premier Gold is an Obamacare health insurance plan offered by BlueCross BlueShield PPO that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Gold metal level plan, which generally has a higher monthly cost but lower deductible (and co-pay), and provides good insurance coverage for people and families who spend more on health care (doctor visits, Rx, tests) than the average person.

  • Deductible amount of $150. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of , which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
Blue Cross Premier Gold

Plan ID:
15560MI0350004

Plan Type:
PPO

Deductible:
$150

Maximum Out-of-Pocket:

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The low out-of-pocket maximum on this plan protects you from having to pay a large medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights


Emergency Room:
$250 then 20% Coinsurance after deductible

Retail Drugs:
25% Coinsurance after deductible

Generic Drugs:
$15 Copay after deductible

Overview


Plan Type:
PPO

Metal Level:
Gold

Health Spending Account:
No

Primary Care Office Visit:
$30 Copay after deductible

Specialist Office Visit:
$50 Copay after deductible

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
Not Covered
Well Baby Care
In Network:
No Charge

Out of Network:
Not Covered

Inpatient

Hospital Services
In Network:
$500 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$500 Copay per Stay then 40% Coinsurance after deductible
Physician Fee
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Skilled Nursing Facility
In Network:
$500 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$500 Copay per Stay then 40% Coinsurance after deductible
Mental Health
In Network:
$500 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
$500 Copay per Stay then 40% Coinsurance after deductible
Substance Abuse
In Network:
$500 Copay per Stay then 20% Coinsurance after deductible

Out of Network:
Not Covered
Home Healthcare
In Network:
20% Coinsurance after deductible

Out of Network:
Not Covered

Outpatient

Surgery
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
X-ray and Diagnostics
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Labs
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Facility Fee
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Mental Health
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Substance Abuse
In Network:
20% Coinsurance after deductible

Out of Network:
Not Covered
Rehabilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Infertility Treatment
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Labor and Delivery Inpatient Services
In Network:
$500 then 20% Coinsurance after deductible

Out of Network:
$500 then 40% Coinsurance after deductible

Dental

Accidental Care
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
No Charge
Glasses (Child)
In Network:
No Charge

Out of Network:
No Charge

Additional Coverage

Chiropractic Care
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Habilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Hospice Service
In Network:
No Charge after deductible

Out of Network:
Not Covered
Diabetes Care Management
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible
Durable Medical Equipment
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Nutritional Consuleling
In Network:
No Charge

Out of Network:
Not Covered
Reconstructive Surgery
In Network:
20% Coinsurance after deductible

Out of Network:
40% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
$30 Copay after deductible

Out of Network:
Not Covered
Specialist Visit
In Network:
$50 Copay after deductible

Out of Network:
Not Covered
Other Practitioner Office Visit
In Network:
$30 Copay after deductible

Out of Network:
Not Covered
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
Not Covered

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$250 then 20% Coinsurance after deductible

Out of Network:
$250 then 20% Coinsurance after deductible
Urgent Care Services
In Network:
$75 then 20% Coinsurance after deductible

Out of Network:
$75 then 40% Coinsurance after deductible
Ambulance/Transportation Services
In Network:
20% Coinsurance after deductible

Out of Network:
20% Coinsurance after deductible

Drugs

Generic Prescription
In Network:
$15 Copay after deductible

Out of Network:
Not Covered
Retail Brand Drugs
In Network:
25% Coinsurance after deductible

Out of Network:
Not Covered
Non Retail Brand Drugs
In Network:
50% Coinsurance after deductible

Out of Network:
Not Covered
Specialty Drugs
In Network:
20% Coinsurance after deductible

Out of Network:
Not Covered

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

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