|
|
|
|
|
|
|
The facilities, doctors and other health care professionals who have agreed to offer care to BCBSNC members at a lower cost. Use of a provider that is not in our network can result in more member expense including higher deductibles, coinsurance and balance billing.
|
|
|
|
|
|
|
Primary doctors and specialists, including surgery, lab work, therapy and radiology when performed by the same doctor on the same day in an office setting.
|
|
|
Copayment for primary care physicians:5 $15 Copayment for specialists: $30
|
|
Copayment for primary care physicians:5 $25 Copayment for specialists: $50
|
|
Copayment for primary care physicians:5 $30 Copayment for specialists: $60
|
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 30%
|
|
|
Routine physical exams, including gynecological exam; well-child and well-baby care, including periodic assessments and immunizations, and other appropriate screenings and tests. Visit bcbsnc.com/preventive for a complete listing of covered services and additional information. Note: Federally mandated preventive care services are not covered out-of-network.
|
|
|
You pay: $0 Preventive services: 100%2 covered
|
|
You pay: $0 Preventive services: 100%2 covered
|
|
You pay: $0 Preventive services: 100%2 covered
|
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 30%
|
|
|
The amount you pay for generic, brand-name and specialty drugs.
|
|
|
Generics: $10 copayment Preferred brand name: $45 copayment Non-preferred brand name: $65 copayment Specialty brand drugs: 25% coinsurance Copayment for brand drugs up to $2,000, then 50% coinsurance** No annual limit for generic drugs
|
|
Deductible: $200 per member Generics: $10 copayment Preferred brand name: $45 copayment Non-preferred brand name: $65 copayment Specialty brand drugs: 25% coinsurance Copayment for brand drugs up to $2,000, then 50% coinsurance** No annual limit for generic drugs
|
|
Deductible: $500 per member Generics: $10 copayment Preferred brand name: $45 copayment Non-preferred brand name: $65 copayment Specialty brands: 25% coinsurance Copayment for brand drugs up to $2,000, then 50% coinsurance** No annual limit for generic drugs
|
|
|
Same as in-network coverage
|
|
Same as in-network coverage
|
|
Same as in-network coverage
|
|
|
The amount you owe for certain covered services during a benefit period before your health insurance begins to pay.
|
|
|
Deductible options: $1,000 or $2,500
|
|
Deductible options: $1,000, $2,500, $3,500 or $5,000
|
|
Deductible options: $3,500 or $5,000
|
|
|
Deductible options: $1,000 or $2,500
|
|
Deductible options: $1,000, $2,500, $3,500 or $5,000
|
|
Deductible options: $3,500 or $5,000
|
|
|
The percentage of covered medical expenses that you pay after you’ve paid your deductible.
|
|
|
After deductible, you pay: 20%
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 50%
|
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 40%
|
|
After deductible, you pay: 60%
|
|
|
The total amount of coinsurance you’re required to pay for covered services in a year. Once you reach the coinsurance maximum, you will not have to pay any more for coinsurance for covered medical expenses for the remainder of the year.
|
|
|
Individual: $2,000; Family: $4,000
|
|
Individual: $3,000; Family: $6,000
|
|
Individual: $3,000; Family: $6,000
|
|
|
Individual: $4,000; Family: $8,000
|
|
Individual: $6,000; Family: $12,000
|
|
Individual: $6,000; Family: $12,000
|
|
|
Inpatient and outpatient facility services, drugs, blood, supplies, medical care, surgical care, therapy services, diagnostic tests, X-rays, lab work.
|
|
|
After deductible, you pay: 20%
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 50%
|
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 40%
|
|
After deductible, you pay: 60%
|
|
Emergency room services and urgent care centers3
|
|
Emergency room services are required by the sudden onset of a condition that could reasonably be expected to place one’s health at risk without immediate medical attention. Urgent care centers provide services for a condition requiring prompt diagnosis or treatment to prevent chronic illness or other complications.
|
|
|
First ER Visit: $150 copayment*** Subsequent ER visits: $500 copayment Urgent Care: $30 copayment
|
|
First ER Visit: $150 copayment*** Subsequent ER visits: $500 copayment Urgent Care: $50 copayment
|
|
First ER Visit: $150 copayment*** Subsequent ER visits: $500 copayment Urgent Care: $60 copayment
|
|
|
Same as in-network coverage
|
|
Same as in-network coverage
|
|
Same as in-network coverage
|
|
Mental health and substance abuse
|
|
Inpatient and outpatient professionals. 10 office visits and 5-day limits are combined for in-network and out-of-network.
|
|
|
After deductible, you pay: 50%
|
|
After deductible, you pay: 50%
|
|
After deductible, you pay: 50%
|
|
|
After deductible, you pay: 50%
|
|
After deductible, you pay: 50%
|
|
After deductible, you pay: 60%
|
|
|
Durable medical equipment, home care, home infusion therapy, hospice care, private duty nursing, ambulance services, skilled nursing facilities (to 60 days per benefit period) and dental accident-related services.
|
|
|
After deductible, you pay: 20%
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 50%
|
|
|
After deductible, you pay: 30%
|
|
After deductible, you pay: 40%
|
|
After deductible, you pay: 60%
|
|