2018 Blue Cross Premier PPO Silver Saver HSA Plan Details - HealthPocket

Blue Cross Premier PPO Silver Saver HSA

$478.63/mo

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Zip Code48228
Applicant8/14/1983 Male
Coverage Start8/15/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Cross Premier PPO Silver Saver HSA
Plan IDhhs-15560MI0350006
Insurance ProviderBlue Cross Blue Shield of Michigan
Metal LevelSilver
Plan TypePPO
Deductible$3,100
Out-of-Pocket Maximum$6,650
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay after deductible
Specialist Visit$50 Copay 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$6200 per group
Out-of-Pocket Maximum - Family$13300 per group

Prescription drug coverage

Generic Drugs$15 Copay after deductible
Preferred Brand Drugs25.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs40.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.bcbsm.com/index/common/find-a-doctor.html
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 - Accidental injury and emergency only
Does this plan cover services outside the country?Yes - Accidental injury and emergency only

Hospital services

Emergency Room Services$250 Copay after deductible, 20.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)20.00% 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 Care$30 Copay after deductible
Delivery and all inpatient services for maternity care20.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$30 Copay after deductible
Mental/Behavioral Health Inpatient Services20.00% Coinsurance after deductible
Substance use disorder outpatient services$30 Copay after deductible
Substance use disorder inpatient services20.00% Coinsurance after deductible

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, Weight Loss 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 CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

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
Infertility Treatment
Weight Loss Programs
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
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Non Preferred Specialty Drugs
Online Visits
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $220
MyPriority Silver 3200 - St. John Providence Network
$3,200.00Select
from $228
MyPriority Silver 3200 - Beaumont Health Network
$3,200.00Select
from $230
MyPriority Silver 3200 - Spectrum Health Partners
$3,200.00Select
from $233
MyPriority Silver 3200 - St. Joseph Mercy Health System Network
$3,200.00Select
from $259
Blue Cross® Metro Detroit HMO Silver Saver
$3,250.00Select
  • 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.

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