![]() $30 copay per treatment up to 12 visits a yearģ5% of our allowance † up to 12 visits a year Inpatient (Precertification is required) : $450 per admission copay, plus 35% of our allowanceĭiagnostic services (such as sleep studies, X-rays, CT scans) Inpatient (Precertification is required) : $350 per admission Outpatient facility care: 35% of our allowance † ![]() Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance ![]() Pre-/postnatal professional care: 35% of our allowance † Tier 5 (Non-preferred specialty): $85 copay Tier 5 (Non-preferred specialty): 30% of our allowance ^ Tier 4 (Preferred specialty): 30% of our allowance ^ Tier 3 (Non-preferred brand): 50% of our allowance Tier 2 (Preferred brand): 30% of our allowance Medical Emergency: 35% our our allowance † $0 for first 2 visits and all nutrition visits Always check the doctor’s networks for each individual plans, and remember that emergency care is covered within the continental US.Nothing for covered preventive screenings, immunizations and services There are no major differences between multi-state plans and other plans, and it does NOT mean these plans provide out of state benefits, just that benefits meet minimum requirements from state to state. The Multi-State Plan (MSP) Program, established under the Affordable Care Act, directs the Federal Office of Personnel Management to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans. These plans are ideal for those who do not have regular medications or visit the doctor outside of their yearly check-up (included as preventative care on all plans.) Bronze plans have higher out of pocket costs, but two plans (the 106 and 104) also have HSA options for those looking for tax savings. Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.īlue Advantage Plus Silver 102 (Three $0 PCP Visits)īlueCross BlueShield of Wisconsin Bronze plans are ideal for individuals looking for low-cost plans. Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up. *Not available on the health exchange marketplace (not subsidy eligible)īlueCross BlueShield Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Prescription Drug Utilization Benefit Management Programs Outpatient Prescription Drugs – Non-Preferred Pharmacy Outpatient Prescription Drugs – Preferred Pharmacy Mental Illness Treatment and Substance Abuse Rehab Office Visit Out-of-Pocket Maximum An out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) Plan Nameĭeductible a specified amount of money that the insured must pay before an insurance company will pay a claim.Ĭoinsurance What % you pay after your deductible has been met and before your out of pocket max You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan. There are deductibles for this plan, and this is an HMO plan. Requires regular prescription medication.Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs.Are willing to have a primary care physician (PCP) coordinate your care.Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans.īlue Advantage Gold HMO Plans may be right for you if you are an individual or family who: The Blue Advantage Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. All Blue Advantage Gold HMO Plans offer the same set of essential health benefits, quality and amount of care as the Blue Advantage Silver and Gold HMO Plans.
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