2019 BlueSelect Gold Balance Plan Details - HealthPocket

BlueSelect Gold Balance

$691.98/mo

Apply For This Plan

Zip Code82001
Applicant9/16/1984 Male
Coverage Start9/17/2019
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlueSelect Gold Balance
Plan IDhhs-11269WY0150018
Plan Year2019
Insurance ProviderBlueCross BlueShield of Wyoming
Metal LevelGold
Plan TypePPO
Deductible$2,000
Out-of-Pocket Maximum$7,900
Personal Score

Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay, 20.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services20.00% Coinsurance after deductible
X-rays and Diagnostic Imaging20.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans20.00% Coinsurance after deductible
Deductible - Family$4000 per group
Out-of-Pocket Maximum - Family$15800 per group

Prescription drug coverage

Generic Drugs$5 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs20.00% Coinsurance after deductible
Specialty Drugs20.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.bcbswy.com/
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state. This network includes discounts, negotiated reimbursement levels, and protection from balance billing.
Does this plan cover services outside the country?Yes - Blue Cross Blue Shield Global Core Have access to doctors and hospitals in more than 200 countries and territories around the world. Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.

Hospital services

Emergency Room Services$500 Copay with deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service20.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care20.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services20.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Substance use disorder outpatient services20.00% Coinsurance after deductible
Substance use disorder inpatient services40.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Skilled Nursing Facility
Cosmetic Surgery
Infertility Treatment
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Well Baby Visits and Care
More Limited BenefitsBariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Hearing Aids
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Nutritional Counseling
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $333
WINhealth Silver
$2,000.00Select
from $350
WINhealth Silver-D
$2,000.00Select
from $516
BlueSelect Gold Balance
$2,000.00Select
/
Please select the correct zip
Shauna, Mckusker
View All Details
Anne, Miller
View All Details
Arthur, Merrell
View All Details
Brian, Horst
View All Details
Erik, Holt
View All Details
Kirk, Shamley
View All Details
Daniel, Fox
View All Details
Sarah, Jordan
View All Details
Aaron, Vernon
View All Details
Meghan, Metz
View All Details
Sarah, Huntley
View All Details
Sarah, Cardenas
View All Details
Alec, Jacobs
View All Details
Sharon, Alexander
View All Details
Traci, Buran
View All Details
Renee, Clontz
View All Details
Asa Foot Cheyenne
View All Details
Joyce, Larsen
View All Details
American Medical Associates, Inc
View All Details
Medical Associates
View All Details
Wyoming Vein Llc
View All Details
Cheyenne Eye Clinic, Llc
View All Details
Shauna Mckusker, M.D.
View All Details
  • Phone Number
    (307) 634-2020
  • Office Locations
    1300 E 20th St
    Cheyenne, WY 82001
1300 E 20th St Cheyenne WY, 82001
  • 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.

Read More

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Close

Health Plans Found

 

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)