Overview - Individuals
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Blue HSA Bronze Intro text
Blue HSA Bronze
Common Plan Benefits
- Calendar Year Deductible: $7,000 Self-only / $14,000 Family
- Out-of-Pocket Maximum: $7,000 Self-only / $14,000 Family
- Health Savings Account (HSA) You have the option to set up an HSA to use for current and future medical expenses.
- Convenient Phone & Video Consultations through Teladocâ„¢ ?
- Financial Assistance Available for this Plan
Plan Overview Accordion Headline
What You Would Pay For In-Network Services:
Blue HSA Bronze Benefit Disclaimer
Complete In-Network and Out-of-Network benefits are listed in the Benefit Booklet.
Blue HSA Bronze Accordion Plan Overview
-
Primary Care Physician
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Specialist
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
For complete coverage details see the Prescription Drug List for this plan.
-
Tier 1
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Tier 2
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Tier 3
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Tier 4
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Tier 5
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Tier 6
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
Learn More About Preventive Services and Preventive Drugs coverage for this plan.
- You Pay:
$0 - We Pay:
100%
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
Limited to members up to the end of the month in which the member turns 19.
-
Routine Dental Cleaning
- You Pay:
$0 after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
-
Yearly Eye Exam
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
- You Pay:
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.