Blue cross blue shield health insurance plans cost

Preventive Care You pay nothing You pay nothing You pay nothing Physician Care

$10 copay per visit for your first 10 primary and/or specialty care visits combined

$30 copay for primary care1
$40 copay for specialists1 $25 copay for primary care
$35 copay for specialists Mental Health Visits $10 copay per visit for your first 10 primary and/or specialty care visits combined $30 copay $25 copay Virtual doctor visits by Teladoc® $0 for first 2 visits
$10 copay all additional visits $0 for first 2 visits
$15 copay all additional visits $0 for first 2 visits
$10 copay all additional visits Urgent Care Center $25 copay $35 copay Accidental Injury: $0
Medical Emergency: $30 copay Prescription Drugs Preferred Retail Pharmacy^:
Tier 1 (Generics): $5 copay
Tier 2 (Preferred brand): 40% of our allowance ($350 max)

Mail Service Pharmacy:
Not a benefit

Specialty Pharmacy^:
Tier 4 (Preferred Generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)

Preferred Retail Pharmacy^:

If you have Medicare Part B primary, your costs for prescription drugs may be lower.

Tier 1 (Generics): $15 copay

Tier 2 (Preferred brand): $60 copay

Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum)

Tier 4 (Preferred specialty): $85 copay

Tier 5 (Non-preferred specialty): $110 copay

Mail Service Pharmacy:

Available to members with Medicare Part B primary only. Visit the Medicare page for more information.

Tier 1 (Generics): $20

Tier 2 (Preferred brand): $100 copay

Tier 3 (Non-preferred brand): $125 copay

Specialty Pharmacy^:

Tier 4 (Preferred specialty): $85 copay

Tier 5 (Non-preferred specialty): $110 copay

Preferred Retail Pharmacy:
If you have Medicare Part B primary, your costs for prescription drugs may be lower.
Tier 1 (Generics): $7.50 copay^
Tier 2 (Preferred brand): 30% of our allowance
Tier 3 (Non-preferred brand): 50% of our allowance
Tier 4 (Preferred specialty): 30% of our allowance^
Tier 5 (Non-preferred specialty): 30% of our allowance^

Mail Service Pharmacy:
Tier 1 (Generics): $15

copay
Tier 2 (Preferred brand): $90 copay
Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy^:
Tier 4 (Preferred specialty): $65
copay
Tier 5 (Non-preferred specialty): $85 copay

Maternity Care $0 for doctor's visits
$1,500 for facility care $250 inpatient
$0 outpatient $0 copay
Hospital Care Inpatient (Precertification is required): 30% of our allowance*
Outpatient: 30% of our allowance* Inpatient (Precertification is required): $250 per day; up to $1,500 per admission
Outpatient: $150 per day per facility1 Inpatient (Precertification is required): $350 per admission
Outpatient: 15% of our allowance* Surgery

30% of our allowance*

$150 in an office setting1
$200 in a non-office setting1

15% of our allowance*

ER (accidental injury) $0 within 72 hours $250 copay per day per facility $0 within 72 hours ER (medical emergency) 30% of our allowance* $250 copay per day per facility 15% of our allowance* Lab work (such as blood tests) $0 for first 10 specific lab tests** 15% of our allowance1 15% of our allowance* Diagnostic services (such as sleep studies, CT scans) 30% of our allowance* Up to $100 in an office1
Up to $200 in a hospital1 15% of our allowance* Chiropractic Care $25 per visit; for up to 10 visits a year1,2 $30 per visit; up to 20 visits per year $25 per visit; up to 12 visits per year Dental Care Not a benefit

$30 per evaluation; up to 2 evaluations per year

The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) Rewards Program Earn a reward at no out-of-pocket cost for getting an annual physical4

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Network Coverage In-network care only, except in certain situations like emergency care In-network care only, except in certain situations like emergency care In-network and out-of-network care Out-of-Pocket Maximum (PPO) Self Only: $8,500
Self + One and Self & Family: $17,000 Self Only: $6,500
Self + One and Self & Family: $13,000 Self Only: $6,000
Self + One and Self & Family: $12,000 Annual Deductible

Self Only: $500

Self + One and Self & Family: $1,000

No deductible

Self Only: $350

Self + One and Self & Family: $700

FEP Blue Focus Plan Page

Basic Option Plan Page

Standard Option Plan Page