Blue Value Gold

Compare and Enroll

Calendar Year Deductible: $750 individual or $1,500 maximum for the entire family

Out-of-Pocket Maximum: $6,000 individual or $12,000 for the entire family

(Once you reach the maximum, you will pay nothing for eligible, in-network expenses for the rest of the year.)

    YOU PAY WE PAY
Physicians visits logo PHYSICIAN VISITS
Primary Care Select Physician and Specialist
Primary Care Physician: $40 copay
Visit your designated Primary Care Select Physician: $25 copay
Specialist: $60 copay
Primary Care Select Physician refers you: $45 copay
100% after the copay
OUTPATIENT SURGERY Lower Member Cost Share: $295 copay
Higher Member Cost Share: $600 copay
100% after the copay
EMERGENCY ROOM
For a medical emergency
$300 copay 100% after the copay
INPATIENT HOSPITAL CARE Lower Member Cost Share: $295 copay/days 1-5
Higher Member Cost Share: $600 copay/days 1-5
100% after the copay
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
Specialist:$60 copay
Primary Care Select Physician refers you: $45 copay
100% after the copay
PRESCRIPTION DRUGS
Source+Rx 1.0 Drug List
Tier 1: $10
Tier 2: $25
Tier 3: $45
Tier 4: $90 copay or 40% coinsurance (whichever is greater)
Tier 5: $175
Tier 6: $250 copay or 20% coinsurance (whichever is greater)
Tiers 1-6: 100% after the copay/ coinsurance
OCCUPATIONAL, PHYSICAL AND SPEECH THERAPY
Up to 30 visits per year
20% after you meet the calendar year deductible 80% after you meet the calendar year deductible
DIAGNOSTIC LAB Lower Member Cost Share: $295 copay
Higher Member Cost Share: $600 copay
100% after the copay
ROUTINE IMMUNIZATIONS
AND PREVENTIVE SERVICES
AlabamaBlue.com/PreventiveServices
$0 100%
PEDIATRIC DENTAL & VISION
Routine Dental Cleaning: $0
Yearly Eye Exam: 20% after you meet the calendar year deductible
Routine Dental Cleaning:100%
Yearly Eye Exam: 80% after you meet the calendar year deductible

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