$116 Single
$324 Family
$122 Single
$340 Family
$103 Single
$285 Family
$113 Single
$314 Family
$97 Single
$264 Family
$110 Single
$306 Family
BluePreferred ValuePlan High Deductible Health Plans, used in combination with a health savings account (HSA), are designed to help you maximize your dollars and minimize your health care expenses.
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $1,200/$2,400 | $2,400/$4,800 |
| Coinsurance Max | $2,000/$4,000 | $4,000/$8,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$3,200/$6,400 | $6,400/$12,800 |
| Coinsurance % for most covered services | 20% | 40% |
| First dollar routine care coverage | N/A | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $1,500/$3,000 | $3,000/$6,000 |
| Coinsurance Max | $0 | $2,000/$4,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$1,500/$3,000 | $5,000/$10,000 |
| Coinsurance % for most covered services | 0% | 20% |
| First dollar routine care coverage | $150 first dollar routine care | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $1,800/$3,600 | $3,600/$7,200 |
| Coinsurance Max | $2,000/$4,000 | $4,000/$8,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$3,800/$7,600 | $7,600/$15,200 |
| Coinsurance % for most covered services | 20% | 40% |
| First dollar routine care coverage | N/A | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $2,250/$4,500 | $4,500/$9,000 |
| Coinsurance Max | $0 | $2,000/$4,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$2,250/$4,500 | $6,500/$13,000 |
| Coinsurance % for most covered services | 0% | 20% |
| First dollar routine care coverage | $150 first dollar routine care | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $2,700/$5,400 | $5,400/$10,800 |
| Coinsurance Max | $2,000/$4,000 | $4,000/$8,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$4,700/$9,400 | $9,400/$18,800 |
| Coinsurance % for most covered services | 20% | 40% |
| First dollar routine care coverage | N/A | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family* |
Out of Network Single/Family* |
|
|---|---|---|
| Deductible | $2,900/$5,800 | $5,800/$11,600 |
| Coinsurance Max | $0 | $2,000/$4,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$2,900/$5,800 | $7,800/$15,600 |
| Coinsurance % for most covered services | 0% | 20% |
| First dollar routine care coverage | $150 first dollar routine care | |
| Maternity care/pregnancy service | No Coverage | |
| Inpatient Mental illness/substance abuse treatment | No Coverage | |
| Outpatient Mental illness/substance abuse treatment | 30% | 60% |
| Prescription Drug Coverage | Coinsurance applies after deductible (Medical plan deductible applies) | |
| Mental illness/substance abuse contract maximum | $10,000 per covered person | |
| Total contract benefit maximum | $10 million per covered person | |