Blue Value Silver

Compare and Enroll

Calendar Year Deductible: $2,600 individual or $5,200 maximum for the entire family.

Out-of-Pocket Maximum: $6,850 individual or $13,700 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:$50 copay
Visit your designated Primary Care Select Physician:$40 copay
Specialist:$65 copay
Primary Care Select Physician refers you:$55 copay
100% after copay
OUTPATIENT SURGERY Lower Member Cost Share: $395 copay
Higher Member Cost Share: $800 copay
100% after copay
EMERGENCY ROOM
For a medical emergency
$400 copay 100% after copay
INPATIENT HOSPITAL CARE
Co-Pays vs Co-Insurance
Lower Member Cost Share: 20% coinsurance
Higher Member Cost Share: 25% coinsurance
Lower Member Cost Share: 80% coinsurance
Higher Member Cost Share: 75% coinsurance
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:$65 copay
Primary Care Select Physician refers you: $55 copay
100% after copay
PRESCRIPTION DRUGS
Source+Rx 1.0 Drug List 
Tier 1: $20
Tier 2: $30
Tier 3: $75
Tier 4: $125 copay or 50% coinsurance (whichever is greater)
Tier 5: $250
Tier 6: $300 copay or 30% coinsurance (whichever is greater)
Tier 1-6: 100% after 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: $395 copay
Higher Member Cost Share: $800 copay
100% after 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.