Benefits & Coverage

Insurance Type
Individual Health Insurance
Insurance Provider
Blue Cross Blue Shield of Rhode Island
Plan Type
PPO
Deductible
$1500
Out-of-Pocket Maximum
$4500
Plan Highlights

    Cost & Coverage

    Estimated Monthly Base Rate
    Estimated monthly premium starts at $177.45
    How many applications are denied?
    3% of the applicants were denied
    How accurate is this estimate?
    0% of the applicants ended up paying a higher amount than the quoted price
    Deductible
    Individual: $1500
    Family: $3000
    In-Network Out-of-Pocket Limit
    Individual: $4500
    Family: $9000
    What is included in the in-network out-of-pocket limit?
    Deductible + Coinsurance
    Is this plan Health Savings Account (HSA) eligible?
    No
    How can I find a doctor in this plan's network?
    Plan Type
    PPO

    Health Services Options

    Service
    In Network
    Out of Network
    Primary care physician office visit
    $20 Copay
    40% Coinsurance after deductible
    Specialist
    $40 Copay
    40% Coinsurance after deductible
    Diagnostic Test (X-ray, blood work)
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Outpatient Facility Fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Outpatient Physician/Surgeon Fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Hospital facility fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Hospital physician/surgeon fee
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Emergency Room
    $200 Copay
    $200 Copay

    Drug Services

    Generic Drugs
    Coverage: $10 Copay
    Preferred Brand Drugs
    Coverage: $35 Copay
    Specialty Drugs
    Coverage: $100 Copay
    What drugs are covered in the formulary?

    Mental Health or Substance Abuse Services

    Service
    In Network
    Out of Network
    Mental/behavioral health outpatient services
    No Charge
    40% Coinsurance after deductible
    Mental/behavioral health inpatient services
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Substance use disorder inpatient services
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Substance use disorder outpatient services
    No Charge
    40% Coinsurance after deductible

    Maternity Services

    Service
    In Network
    Out of Network
    Prenatal/postnatal care
    20% Coinsurance after deductible
    40% Coinsurance after deductible
    Delivery and all inpatient services for maternity care
    20% Coinsurance after deductible
    40% Coinsurance after deductible

    Coverage Options Summary

    Included Benefits
    • Bariatric surgery
    • Chiropractic
    • Durable medical equipment
    • Emergency Transportation
    • Eye exam adult
    • Habilitation
    • Hearing Aid
    • Home health care
    • Hospice
    • Imaging (CT/PET scans, MRIs)
    • Infertility treatment
    • Inpatient rehabilitation
    • Non-emergency care outside U.S.
    • Non-preferred brand drugs
    • Skilled nursing care
    • Other practitioner office visit
    • Outpatient rehabilitation
    • Preventive care, screening, immunization
    • Routine eye exam children
    • Routine hearing tests
    • Urgent Care
    Excluded Benefits
    • Acupuncture
    • Cosmetic surgery
    • Dental care adult
    • Dental check up children
    • Eye glasses children
    • Long Term Care
    • Private duty nursing
    • Weight loss program
    Limited Benefits
    • Routine foot care

    What To Know

    • 3%of the applicants were denied
    • 0%of the applicants ended up paying a higher amount than the quoted price
    • Deductible amount is NOT included as part of the out-of-pocket limit

    Physician Directory

    List of doctors that accepts VantageBlue Direct 1500/3000 Plan in Rhode island

    /
    KHATIB, PERVEZ
    100 CURTIS ST
    PROVIDENCE, RI 02909
    MASTROSTEFANO, PASQUALE
    347 BROADWAY
    PROVIDENCE, RI 02909
    VANDYCK, WALTER
    SPRINGFIELD MIDDLE SCHOOL, PROVIDENE SCHOOL DEPARTMENT
    PROVIDENCE, RI 02909
    LESPINASSE, MAGGY
    239 CRANSTON ST
    PROVIDENCE, RI 02907
    SCOTT, WALTER
    655 BROAD ST
    PROVIDENCE, RI 02907
    THOMAS, LONICE
    239 CRANSTON ST
    PROVIDENCE, RI 02907
    MAGLIO, DAVID
    178 DEXTER ST
    PROVIDENCE, RI 02907
    STUTZ, STANLEY
    21 PEACE ST
    PROVIDENCE, RI 02907
    TAMAN, MAGED
    21 PEACE STREET
    PROVIDENCE, RI 02907
    KELLY, CARRIE
    21 PEACE ST
    PROVIDENCE, RI 02907
    MUKAND, JON
    21 PEACE ST
    PROVIDENCE, RI 02907
    CLARK-MEDYESY, MELANIE
    176 CONGRESS AVE
    PROVIDENCE, RI 02907
    ABEJUELA, MARIE
    21 PEACE ST
    PROVIDENCE, RI 02907
    GURNEY, ELLEN
    239 CRANSTON ST.
    PROVIDENCE, RI 02907
    SKURKOVICH, BORIS
    239 CRANSTON ST
    PROVIDENCE, RI 02907
    CECE, JOHN
    230 RESERVOIR AVE
    PROVIDENCE, RI 02907
    RODRIGUEZ-PERIS, EMILIO
    655 BROAD STREET
    PROVIDENCE, RI 02907
    JARBEAU, JENNIFER
    1076 NORTH MAIN STREET
    PROVIDENCE, RI 02904
    INDEGLIA, ROBERT
    208 COLLYER ST
    PROVIDENCE, RI 02904
    COTTIERO, RICHARD
    1076 N MAIN ST
    PROVIDENCE, RI 02904
    ESTRADA, ELKIN
    1076 N MAIN ST
    PROVIDENCE, RI 02904
    PHARMAKIDIS, ANGELO
    1637 MINERAL SPRING AVE
    NORTH PROVIDENCE, RI 02904
    CLEMENT, JEFFREY
    1076 N MAIN ST
    PROVIDENCE, RI 02904
    SILVER, MICHAEL
    530 N MAIN ST
    PROVIDENCE, RI 02904
    ROSENBERG, JERROLD
    827 N MAIN ST
    PROVIDENCE, RI 02904
    Details
    PERVEZ KHATIB, MD
    Phone Number
    (401) 444-0540
    Office Locations
    100 CURTIS ST
    PROVIDENCE, RI 02909
    100 CURTIS ST PROVIDENCE RI, 02909

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