Blue HSA Gold

Compare and Enroll

Common Plan Benefits

- Calendar Year Deductible: $1,750 Individual / $3,500 Family

- Out-of-Pocket Maximum: $6,000 Individual / $12,000 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 Teladoc™ ?

 

What You Would Pay For In-Network Services:

Complete In-Network and Out-of-Network benefits are listed in the Benefit Booklet.

  • Primary Care Physician

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Specialist

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% 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:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Tier 2

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Tier 3

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Tier 4

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Tier 5

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible
  • Tier 6

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% after meeting the calendar year deductible

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

  • You Pay:
    10% after meeting the calendar year deductible
  • We Pay:
    90% 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
  • Yearly Eye Exam

    • You Pay:
      10% after meeting the calendar year deductible
    • We Pay:
      90% after meeting the calendar year deductible

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

Don't forget...

We also offer Dental, Vision and Travel insurance.