Blue Advantage Silver PPO 605 Plan Details for 2021- HealthPocket

Insurance Type	ACA (Obamacare)
Plan Name	Blue Advantage Silver PPO 605
Plan ID	hhs-87571OK0350120
Plan Year	2021
Insurance Provider	Blue Cross Blue Shield of Oklahoma
Metal Level	Silver
Plan Type	PPO
Deductible	$0
Out-of-Pocket Maximum	$8,700
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$80 Copay
Specialist Visit	$115 Copay
Laboratory Outpatient and Professional Services	50% Coinsurance
X-rays and Diagnostic Imaging	50% Coinsurance
Diagnostic Imaging such as MRIs, CT, and PET scans	50% Coinsurance
Deductible - Family	$0 per group
Out-of-Pocket Maximum - Family	$17400 per group

Prescription drug coverage
Generic Drugs	$30 Copay
Preferred Brand Drugs	50% Coinsurance
Non-Preferred Brand Drugs	50% Coinsurance
Specialty Drugs	50% Coinsurance

Access to doctors and hospitals
Provider directory URL	http://public.hcsc.net/providerfinder/home.do?corpEntCd=OK8
Does this plan have access to a national provider network?	Yes
Is a referral required to see a Specialist?	No -
Does this plan cover services outside plan service area?	Yes - When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are Participating Providers) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (Host Blue). In some instances, you may obtain care from Non-Participating Providers.
Does this plan cover services outside the country?	Yes - This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Hospital services
Emergency Room Services	$950 Copay with deductible, 50% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)	$400 Copay per Stay with deductible, 50% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services	50% Coinsurance after deductible
Emergency Transportation or Ambulance Service	50% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	$80 Copay
Delivery and all inpatient services for maternity care	$400 Copay with deductible, 50% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health
Mental/Behavioral Health Outpatient Services	50% Coinsurance
Mental/Behavioral Health Inpatient Services	$400 Copay per Stay with deductible, 50% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services	50% Coinsurance
Substance use disorder inpatient services	$400 Copay per Stay with deductible, 50% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does this plan offer a wellness program?	Not Covered

Vision Coverage
Routine Eye Exam for Children	Covered
Eye Glasses for Children	Covered
Routine Eye Exam for Adults	Not Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Well Baby Visits and Care Prescription Drugs Other Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Hearing Aids Private-Duty Nursing Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Treatment for Temporomandibular Joint Disorders Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $434	Ambetter Essential Care: $0 Medical Deductible	$0.00	Select
from $454	Ambetter Essential Care: $0 Medical Deductible + Vision + Adult Dental	$0.00	Select
from $703	BlueLincs Gold HMO? 200	$100.00	Select

Last Name

Location/Distance

Please select the correct zip

Gordon, Bean

Bryan, Treacy

Rosemary, Ayitey

Dawna, Mccreight

Jennifer, Alexander

Optim Oncology Moore

Ashley, Condit

Allison, Clanton

Emily, Leonhardt

Bethany Elizabeth, Finkbeiner

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Therapy In Motion Of Oklahoma Llc

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Natalie, Wansick

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Peyton, Joines

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Brooke, Dressendorfer

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Joseph, Weber

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Bruce, Rau

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Restorative Health Solutions, Llc

Christina, Zitzow

Karinda, Polk

Kimberly, Cusher

Tammie, Haworth

Darren Elenburg Dpm Pc

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Julie, Watson

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Gordon Bean, DPM

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Phone Number
(405) 794-6691
Office Locations
3001 S Telephone Rd
Moore, OK 73160

What Is the Silver Plan?
ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.
How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.
How much does a Silver Plan cost?
The monthly premium for a Silver 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 the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.
When Can I Enroll in a Silver 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.

Zip Code	73160 (edit)
Applicant	6/29/1987 Male (edit)

Zip Code	73160 (edit)
Applicant	6/29/1987 Male (edit)

Blue Advantage Silver PPO 605

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

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Silver plan frequently asked questions (FAQ)

What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

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Health Plans Found

Blue Advantage Silver PPO 605

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

Related Articles

Related Searches

Silver plan frequently asked questions (FAQ)

What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

Apply For This Plan

Health Plans Found

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