Blue Saver® Bronze

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Calendar Year Deductible: $7,150 individual or $14,300 maximum for the entire family.

Out-of-Pocket Maximum: $7,150 individual or $14,300 for the entire family.
(Once you reach the maximum, you will pay nothing for eligible, in-network expenses for the rest of the year.)

IMPORTANT: This plan uses the Select Lab Network.

    YOU PAY WE PAY
Physicians visits logo PHYSICIAN VISITS
Primary Care Physician and Specialist
First 2 illness-related visits: $40 copay
Thereafter: 0% after you meet the calendar year deductible
First 2 illness-related visits: 100% after copay
Thereafter: 100% after you meet the calendar year deductible
OUTPATIENT SURGERY 0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
EMERGENCY ROOM
For a medical emergency
0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
INPATIENT HOSPITAL CARE 0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
MATERNITY CARE
Physician Benefits
0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
MENTAL HEALTH
Office Visit or Consultation
First 2 illness-related visits: $40 copay
Thereafter: 0% after you meet the calendar year deductible
First 2 illness-related visits: 100% after copay
Thereafter: 100% after you meet the calendar year deductible
PRESCRIPTION DRUGS
Source+Rx 1.0 Drug List
Tier 1: $20
Tier 2: $35
Tier 3-6: 0% after you meet the calendar year deductible
Tier 1-2: 100% after the copay
Tier 3-6: 100% after you meet the calendar year deductible
OCCUPATIONAL, PHYSICAL AND SPEECH THERAPY
Up to 30 visits per year
0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
DIAGNOSTIC LAB 0% after you meet the calendar year deductible 100% after you meet the calendar year deductible
ROUTINE IMMUNIZATIONS
AND PREVENTIVE SERVICES
AlabamaBlue.com/PreventiveServices
$0 100%
PEDIATRIC DENTAL & VISION
Routine Dental Cleaning: $0
Yearly Eye Exam: 0% after you meet the calendar year deductible
Routine Dental Cleaning: 100%
Yearly Eye Exam: 100% after you meet the calendar year deductible

*Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.