Prémio mensal

383.73
BlueSolutions for HSA Direct 1700/3400
medical
2022
Gold
https://www.bcbsri.com/individual/shop/medical/2022/bluesolutions-hsa-direct-17003400-directonly

Who will be covered

Selecting this plan will add coverage for :

Gold

BlueSolutions for HSA Direct

1700/3400

This plan offers a high level of coverage once you meet your deductible, with the added benefit of an optional health savings account (HSA) to pay for medical expenses. You’ll have access to the national network of doctors (across all 50 states), labs, and hospitals.

  • Full coverage for many preventive services, like an annual physical, when you use a doctor in the national network
  • You receive tax advantages when you open an HSA
  • MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases count toward your deductible*
  • Includes dental and vision coverage for dependents under the age of 19
  • $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • Earn up to $250 (both subscriber and covered spouse) in wellness rewards
  • Member discounts with Blue 365 on gyms, nutrition services, fitness trackers, and more health and lifestyle brands
  • View benefit information and manage your HSA on myBCBSRI

O que está coberto

Veja se o seu médico está na rede
Pesquise fornecedores

Benefícios médicos e hospitalares

Cobertura

In-Network You Pay

Cobertura médica

Preventive Services

$0

Primary Care Provider (PCP) Office Visit when affiliated with a patient-centered medical home (PCMH)

$15 after deductible

PCP not affiliated with a PCMH

$35 after deductible

Doctors Online (designated telemedicine provider)

$0 after deductible

Retail Clinic

$40 after deductible

Consulta de especialista

$40 after deductible

Acupuncture Treatment

$45 after deductible (12 visits per year)

Urgent Care Center

$75 after deductible

Serviço de urgência

$300 after deductible

Diagnostic Laboratory Tests

$0 after deductible

X-rays

$0 after deductible

High-End Radiology (for example, MRI, PET, and CAT scans)

$150 after deductible

Inpatient Hospital

$300 per admission after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

$0 after deductible

Pediatric Dental (Dependent under 19)

Oral exams, cleanings, x-rays, fluoride treatments, sealants and space maintainers

$0 after deductible

All other covered dental services 

50% after deductible

Benefícios de medicamentos prescritos

Cobertura

In-Network You Pay

Nível 1 (genérico preferido)

$10 after deductible

Nível 2 (genérico não-preferido)

$25 after deductible

Nível 3 (marca preferida)

$50 after deductible

Tier 4 (Non-Preferred Brand)

$75 after deductible

Tier 5 (Specialty)

$125 after deductible

*MedsYourWay is not insurance. It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services. Ask your pharmacy if they participate in MedsYourWay before filling your prescription.

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