Blue Secure Silver

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Blue Secure Silver
Plan Year
2016
Insurance Type
Individual Health Insurance (Obamacare)
Metal Level
Silver
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$40 Copay
Specialist Visit
$65 Copay
Laboratory Outpatient and Professional Services
No Charge
X-rays and Diagnostic Imaging
$350 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$350 Copay
Out-of-Pocket Maximum - Family
$13700 per group

Prescription drug coverage

Generic Drugs
$25 Copay
Preferred Brand Drugs
$75 Copay
Non-Preferred Brand Drugs
$125 Copay
Specialty Drugs
$425 Copay

Access to doctors and hospitals

Provider directory URL
https://www.bcbsal.org/webapps/providerfinderplus/Dispatch?application=org.bcbsal.providerfinderplus.ProviderFinderPlusApplication
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 - If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.
Does this plan cover services outside the country?
Yes - If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.

Hospital services

Emergency Room Services
$350 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
$350 Copay per Day
Inpatient Physician and Surgical Services
0% Coinsurance after deductible
Emergency Transportation or Ambulance Service
20% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
0% Coinsurance after deductible
Delivery and all inpatient services for maternity care
0% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$65 Copay
Mental/Behavioral Health Inpatient Services
No Charge
Substance use disorder outpatient services
$65 Copay
Substance use disorder inpatient services
No Charge

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Diabetes, Heart Disease, Pregnancy
Does this plan offer a wellness program?
Included

Vision Coverage

Routine Eye Exam for Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Not Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Included
Child Dental Coverage - Basic Dental Care
Included
Child Dental Coverage - Orthodontia
Included
Child Dental Coverage - Major Dental Care
Included

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
Infertility Treatment
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
Non-Emergency Care When Traveling Outside the U.S.
Accidental Dental
Allergy Testing
Chemotherapy
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Off Label Prescription Drugs
Telephone and Online Video Physician Consultation
More Limited Benefits
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Diabetes Education
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Air Ambulance
More Excluded Benefits
Skilled Nursing Facility
Acupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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