Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Blue Cross Blue Shield of Rhode Island
Metal Level
Gold
Plan Type
Other/Describe
Deductible
$1500
Out-of-Pocket Maximum
$2250
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $318.44
Deductible
Individual: $1500
Family: $3000
In-Network Out-of-Pocket Limit
Individual: $2250
Family: $4500
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
Other/Describe

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
0% Coinsurance after deductible
40% Coinsurance after deductible
Specialist
0% Coinsurance after deductible
40% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
0% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Facility Fee
0% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
0% Coinsurance after deductible
40% Coinsurance after deductible
Hospital facility fee
0% Coinsurance after deductible
40% Coinsurance after deductible
Hospital physician/surgeon fee
0% Coinsurance after deductible
40% Coinsurance after deductible
Emergency Room
0% Coinsurance after deductible
0% Coinsurance after deductible

Drug Services

Generic Drugs
Coverage: $3 Copay after deductible
Preferred Brand Drugs
Coverage: $35 Copay after deductible
Specialty Drugs
Coverage: $100 Copay after deductible
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
0% Coinsurance after deductible
40% Coinsurance after deductible
Mental/behavioral health inpatient services
0% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder inpatient services
0% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder outpatient services
0% Coinsurance after deductible
40% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
0% Coinsurance after deductible
40% Coinsurance after deductible
Delivery and all inpatient services for maternity care
0% Coinsurance after deductible
40% Coinsurance after deductible

Coverage Options Summary

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

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

List of doctors that accepts BlueSolutions for HSA Direct 1500/3000 Obamacare 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
GURNEY, ELLEN
239 CRANSTON ST.
PROVIDENCE, RI 02907
LESPINASSE, MAGGY
239 CRANSTON ST
PROVIDENCE, RI 02907
THOMAS, LONICE
239 CRANSTON ST
PROVIDENCE, RI 02907
SKURKOVICH, BORIS
239 CRANSTON ST
PROVIDENCE, RI 02907
MAGLIO, DAVID
178 DEXTER ST
PROVIDENCE, RI 02907
CECE, JOHN
230 RESERVOIR AVE
PROVIDENCE, RI 02907
STUTZ, STANLEY
21 PEACE ST
PROVIDENCE, RI 02907
TAMAN, MAGED
21 PEACE STREET
PROVIDENCE, RI 02907
RODRIGUEZ-PERIS, EMILIO
655 BROAD STREET
PROVIDENCE, RI 02907
KELLY, CARRIE
21 PEACE ST
PROVIDENCE, RI 02907
MUKAND, JON
21 PEACE ST
PROVIDENCE, RI 02907
SCOTT, WALTER
655 BROAD ST
PROVIDENCE, RI 02907
CLARK-MEDYESY, MELANIE
176 CONGRESS AVE
PROVIDENCE, RI 02907
ABEJUELA, MARIE
21 PEACE ST
PROVIDENCE, RI 02907
TRIEDMAN, SCOTT
825 N MAIN ST
PROVIDENCE, RI 02904
MASKO, GABRIELA
825 N MAIN ST
PROVIDENCE, RI 02904
JOYCE, DONALD
825 N MAIN ST
PROVIDENCE, RI 02904
OLDENBURG, NICKLAS
825 N MAIN ST
PROVIDENCE, RI 02904
SCHNEIDER, FRANKLIN
1076 NORTH MAIN STREET
PROVIDENCE, RI 02904
MERINGOLO, ROBERT
1076 NORTH MAIN STREET
PROVIDENCE, RI 02904
SCHWENGEL, ROBERT
1076 NORTH MAIN STREET
PROVIDENCE, RI 02904
ABADI, CHRISTOPHER
1076 NORTH MAIN STREET
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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