Blue Cross Select Silver

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Common Plan Benefits

- Calendar Year Deductible: $2,800 Individual / $5,600 Family

- Out-of-Pocket Maximum: $7,900 Individual / $15,800 Family

- Convenient Phone & Video Consultations through Teladoc™ ?

Financial Assistance Available for this Plan

BENEFIT REQUIREMENTS
This plan requires you and all covered members on the plan to designate a Primary Care Select Physician for benefits to be paid. If a Primary Care Select physician is not designated, no benefits are payable under the plan.

In Alabama, you must be referred to a specialist by your Primary Care Select physician. If no referral, no benefits are payable under the 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 Select Physician

    • You Pay:
      $40 copay
      Each member must designate a Primary Care Select Physician
    • We Pay:
      100% after the copay
  • Specialist

    • You Pay:
      $65 copay
      Each member must be referred by designated Primary Care Select Physician
    • We Pay:
      100% after the copay

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

  • Lower Member Cost Share

    • You Pay:
      $600 copay
    • We Pay:
      100% after the copay
  • Higher Member Cost Share

    • You Pay:
      $1,000 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:
    $600 copay
  • We Pay:
    100% after the copay

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

  • Lower Member Cost Share

    • You Pay:
      20% coinsurance
    • We Pay:
      80% coinsurance
  • Higher Member Cost Share

    • You Pay:
      25% coinsurance
    • We Pay:
      75% coinsurance

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: $65 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.

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

  • Tier 1

    • You Pay:
      $20 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 2

    • You Pay:
      $30 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 3

    • You Pay:
      $85 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 4

    • You Pay:
      $150 copay or 50% coinsurance (whichever is greater)
    • We Pay:
      100% after copay/coinsurance
  • Tier 5

    • You Pay:
      $250 copay
    • We Pay:
      100% after copay/coinsurance
  • Tier 6

    • You Pay:
      $300 copay or 30% 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.

IMPORTANT: Use a Select Lab Network to provide services under your plan.

  • Lower Member Cost Share

    • You Pay:
      $600 copay
    • We Pay:
      100% after the copay
  • Higher Member Cost Share

    • You Pay:
      $1,000 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.