Capital Blue Cross

Capital Blue Cross | Healthy Benefits PPO 4500.0

  • Healthy Benefits PPO 4500.0 is an Obamacare health insurance plan offered by Capital Blue Cross 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 Silver metal level plan, which generally has a mid-level monthly cost and deductible (and co-pay), and provides middle-of-the-road insurance coverage for people who occasionally use their health care benefits (doctors, prescription drugs, etc.).

  • Deductible amount of $4,500. 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 $6,850, 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:
Healthy Benefits PPO 4500.0

Plan ID:
45127PA0020008

Plan Type:
PPO

Deductible:
$4,500

Maximum Out-of-Pocket:
$6,850

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a moderate monthly cost is great for individuals and families who occasionally visit the doctor or use prescription drugs. The very high deductible on this plan means you will pay a significant amount of money of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive 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


Dental Coverage:
Child

Emergency Room:
$150

Retail Drugs:
$25 Copay after deductible

Generic Drugs:
$5 Copay after deductible

Overview


Plan Type:
PPO

Metal Level:
Silver

Health Spending Account:
No

Primary Care Office Visit:
$10

Specialist Office Visit:
$20

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Well Baby Care
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Physician Fee
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Skilled Nursing Facility
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Home Healthcare
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible

Outpatient

Surgery
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
X-ray and Diagnostics
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Labs
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Facility Fee
In Network:
No Charge after deductible

Out of Network:
Not Covered
Mental Health
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services
In Network:
$20

Out of Network:
50% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Labor and Delivery Inpatient Services
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible

Dental

Accidental Care
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Basic Dental Care (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Dental Checkup (Child)
In Network:
No Charge

Out of Network:
20%
Major Dental Care (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Orthodontia (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
Not Covered

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
70%
Glasses (Child)
In Network:
No Charge

Out of Network:
70%

Additional Coverage

Chiropractic Care
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Habilitation Services
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Hospice Service
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Diabetes Care Management
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Durable Medical Equipment
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible
Reconstructive Surgery
In Network:
No Charge after deductible

Out of Network:
50% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
$10

Out of Network:
50% Coinsurance after deductible
Specialist Visit
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$150

Out of Network:
$150
Urgent Care Services
In Network:
$75

Out of Network:
$75
Ambulance/Transportation Services
In Network:
No Charge

Out of Network:
No Charge

Drugs

Generic Prescription
In Network:
$5 Copay after deductible

Out of Network:
50% Coinsurance after deductible
Retail Brand Drugs
In Network:
$25 Copay after deductible

Out of Network:
50% Coinsurance after deductible
Non Retail Brand Drugs
In Network:
$60 Copay after deductible

Out of Network:
50% Coinsurance after deductible
Specialty Drugs
In Network:
$285 Copay after deductible

Out of Network:
50% Coinsurance after deductible

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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