Blue Value Gold

Compare and Enroll

Common Plan Benefits

- Calendar Year Deductible: $750 Individual / $1,500 Family

- Out-of-Pocket Maximum: $6,000 Individual / $12,000 Family

- Convenient Phone & Video Consultations through Teladoc™ ?

Financial Assistance Available for this Plan

 

What You Would Pay For In-Network Services:

Complete In-Network and Out-of-Network benefits are listed in the Benefit Booklet.

  • Primary Care Physician

    • You Pay:
      $40 copay
      Receive a discounted copay of $25 when visiting your designated Primary Care Select Physician
    • We Pay:
      100% after the copay
  • Specialist

    • You Pay:
      $60 copay
      Receive a discounted copay of $45 when referred by designated Primary Care Select Physician
    • We Pay:
      100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • Lower Member Cost Share

    • You Pay:
      $300 copay
    • We Pay:
      100% after the copay
  • Higher Member Cost Share

    • You Pay:
      $600 copay
    • We Pay:
      100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • You Pay:
    $300 copay
  • We Pay:
    100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • Lower Member Cost Share

    • You Pay:
      $300 copay per day (days 1-5)
    • We Pay:
      100% after the copay
  • Higher Member Cost Share

    • You Pay:
      $600 copay per day (days 1-5)
    • We Pay:
      100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • You Pay:
    0% after meeting the calendar year deductible
  • We Pay:
    100% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • You Pay:
    Specialist: $60 copay
    Receive a discounted copay of $45 when referred by designated Primary Care Select Physician
  • We Pay:
    100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

For complete coverage details see the Prescription Drug List for this plan.

  • Tier 1

    • You Pay:
      $10 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 2

    • You Pay:
      $25 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 3

    • You Pay:
      $45 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 4

    • You Pay:
      $90 copay or 40% coinsurance (whichever is greater)
    • We Pay:
      100% after copay/coinsurance
  • Tier 5

    • You Pay:
      $175 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 6

    • You Pay:
      $250 copay or 20% coinsurance (whichever is greater)
    • We Pay:
      100% after copay/coinsurance

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • You Pay:
    20% after meeting the calendar year deductible
  • We Pay:
    80% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

  • Lower Member Cost Share

    • You Pay:
      $300 copay
    • We Pay:
      100% after the copay
  • Higher Member Cost Share

    • You Pay:
      $600 copay
    • We Pay:
      100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Learn More About Preventive Services and Preventive Drugs coverage for this plan.

  • You Pay:
    $0
  • We Pay:
    100%

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Limited to members up to the end of the month in which the member turns 19.

  • Routine Dental Cleaning

    • You Pay:
      $0 
    • We Pay:
      100%
  • Yearly Eye Exam

    • You Pay:
      20% after meeting the calendar year deductible
    • We Pay:
      80% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Don't forget...

We also offer Dental, Vision and Travel insurance.