Prémio mensal

366.31
BlueCHiP Direct 2300/4600
medical
2023
Gold
https://www.bcbsri.com/individual/shop/medical/2023/bluechip-direct-23004600

Who will be covered

Selecting this plan will add coverage for :

Gold

BlueCHiP Direct

2300/4600

This is the lowest-cost plan that Blue Cross offers in the gold tier. Your primary care provider (PCP) directs most of your care and referrals to other doctors. This plan covers office visits and generic drugs before the deductible, and it uses our local RI network, which includes all Rhode Island hospitals.

  • Full coverage for many preventive services, like an annual physical, when you use a doctor in the network
  • MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases accumulate toward your deductible (if applicable) and out-of-pocket maximum.*
  • No-cost dental exam and cleaning for members under 19
  • Earn up to $250 (both subscriber and spouse) in wellness rewards
  • Member discounts with Blue 365 on gyms, nutrition services, fitness trackers, and more health and lifestyle brands
  • $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • This plan uses our RI network, which includes all Rhode Island hospitals, 1,300+ primary care doctors, and 3,400 specialty doctors
  • View benefit information 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

PCP not affiliated with a PCMH

$35

Doctors Online (designated telemedicine provider)

$35

Retail clinic

$45

Specialist visit

$45

Acupuncture treatment

$45 (12 visits per year)

Serviço de urgência

$75

Serviço de urgência

10% after deductible

Diagnostic laboratory tests

10% after deductible

X-rays

10% after deductible

High-end radiology (MRI, PET, CAT scan, etc.)

10% after deductible

Inpatient hospital

10% after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

10% after deductible

Pediatric Dental (Dependent under 19)

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

$0

All other covered dental services 

50% after deductible

Benefícios de medicamentos prescritos

Cobertura

In-Network You Pay

Nível 1 (genérico preferido)

$10

Nível 2 (genérico não-preferido)

$25

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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