2019 Blue Advantage Gold 2500 (broad network) Plan Details - HealthPocket

Blue Advantage Gold 2500 (broad network)

$593.24/mo

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Zip Code28269
Applicant12/10/1983 Male
Coverage Start12/11/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Advantage Gold 2500 (broad network)
Plan IDqhp-11512NC0060018
Plan Year2019
Insurance ProviderBlue Cross Blue Shield of North Carolina
Metal LevelGold
Plan TypePPO
Deductible$2,500
Out-of-Pocket Maximum$7,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$5 Copay
Specialist Visit$30 Copay
Laboratory Outpatient and Professional Services20% Coinsurance after deductible
X-rays and Diagnostic Imaging20% Coinsurance after deductible
Deductible - Family$5000
Out-of-Pocket Maximum - Family$15800

Prescription drug coverage

Generic Drugs$4 Copay
Preferred Brand Drugs$35 Copay
Non-Preferred Brand Drugs$80 Copay
Specialty Drugs25% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services$500 Copay
Inpatient Hospital Services (e.g., Hospital Stay)20% Coinsurance after deductible
Inpatient Physician and Surgical Services20% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care20% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient Services20% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for Children50.00%

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Bariatric Surgery
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Dental Check-Up for Children
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
Non-Emergency Care When Traveling Outside of the U.S.
Dental Anesthesia
Diabetes Care Management
Clinical Trials
Congenital Anomaly, including Cleft Lip/Palate
Tier 2 Rx
Tier 6 Rx
Prenatal and Postnatal Care - Non-Global Maternity
More Excluded BenefitsLong-Term/Custodial Nursing Home Care
Cosmetic Surgery
Off-label Prescription Drugs
Acupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Prosthetic Devices
PremiumPlan NameDeductible
from $382
Blue Value Gold 2500 (limited network with UNC Health Alliance)
$2,500.00Select
from $475
Blue Value Gold 2500 (limited network)
$2,500.00Select
from $495
Blue Local Gold 2500 (local network with Atrium Health)
$2,500.00Select
from $557
Blue Select Gold 2500 (tiered network)
$2,500.00Select
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  • Phone Number
    (704) 863-9830
  • Office Locations
    5727 Prosperity Crossing Drive
    Charlotte, NC 28269
5727 Prosperity Crossing Drive Charlotte NC, 28269
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.