2018 Blue Cross® Premier PPO Bronze Extra Plan Details - HealthPocket

Blue Cross® Premier PPO Bronze Extra


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Zip Code48228
Applicant10/20/1983 Male
Coverage Start10/22/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Cross® Premier PPO Bronze Extra
Plan IDqhp-15560MI1120001
Plan Year2018
Insurance ProviderBlue Cross Blue Shield of Michigan
Metal LevelExpanded Bronze
Plan TypePPO
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist Visit$75 Copay
Deductible - Family$13300
Out-of-Pocket Maximum - Family$14700

Prescription drug coverage

Generic Drugs$35 Copay
Preferred Brand Drugs35% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs45% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible
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