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Blue Cross Select Gold Intro text
Blue Cross Select Gold
Common Plan Benefits
- Calendar Year Deductible: $850 Individual / $1,700 Family
- Out-of-Pocket Maximum: $6,000 Individual / $12,000 Family
- Convenient Phone & Video Consultations through Teladoc™ ?
- Financial Assistance Available for this Plan
This plan requires you and all covered members on the plan to designate a primary care select physician for benefits to be paid. If a primary care celect physician is not designated, no benefits are payable under the plan.
In Alabama, you must be referred to a specialist by your primary care select physician. If no referral, no benefits are payable under the plan.
Plan Overview Accordion Headline
What You Would Pay For In-Network Services:
Blue Cross Select Gold Benefits Disclaimer
Complete In-Network and Out-of-Network benefits are listed in the Benefit Booklet.
Blue Cross Select Gold Accordion Plan Overview
-
Primary Care Select Physician
- You Pay:
$35 copay
Each member must designate a Primary Care Select Physician - We Pay:
100% after the copay
- You Pay:
-
Specialist
- You Pay:
$50 copay
Each member must be referred by designated Primary Care Select Physician - We Pay:
100% after the copay
- You Pay:
Understand Copays vs Coinsurance
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
-
Lower Member Cost Share
- You Pay:
$300 copay - We Pay:
100% after the copay
- You Pay:
-
Higher Member Cost Share
- You Pay:
$600 copay - We Pay:
100% after the copay
- You Pay:
Understand Copays vs Coinsurance
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
$300 copay - We Pay:
100% after the copay
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
-
Lower Member Cost Share
- You Pay:
$300 copay per day (days 1-5) - We Pay:
100% after the copay
- You Pay:
-
Higher Member Cost Share
- You Pay:
$600 copay per day (days 1-5) - We Pay:
100% after the copay
- You Pay:
Understand Copays vs Coinsurance
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
0% after meeting the calendar year deductible - We Pay:
100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
Specialist: $50 copay - We Pay:
100% after the copay
Understand Copays vs Coinsurance
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 copay - We Pay:
100% after copay/coinsurance
- You Pay:
-
Tier 2
- You Pay:
$20 copay - We Pay:
100% after copay/coinsurance
- You Pay:
-
Tier 3
- You Pay:
$45 copay - We Pay:
100% after copay/coinsurance
- You Pay:
-
Tier 4
- You Pay:
40% coinsurance - We Pay:
100% after copay/coinsurance
- You Pay:
-
Tier 5
- You Pay:
$175 copay - We Pay:
100% after copay/coinsurance
- You Pay:
-
Tier 6
- You Pay:
20% coinsurance - We Pay:
100% after copay/coinsurance
- You Pay:
Understand Copays vs Coinsurance
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
- You Pay:
20% after meeting the calendar year deductible - We Pay:
80% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
-
Lower Member Cost Share
- You Pay:
$300 copay - We Pay:
100% after the copay
- You Pay:
-
Higher Member Cost Share
- You Pay:
$600 copay - We Pay:
100% after the copay
- You Pay:
Understand Copays vs Coinsurance
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 - We Pay:
100%
- You Pay:
-
Yearly Eye Exam
- You Pay:
20% after meeting the calendar year deductible - We Pay:
80% after meeting the calendar year deductible
- You Pay:
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.