Budget-friendly BlueEssentials plans cover your essential health care coverage needs.
| In Network Single/Family |
Out of Network Single/Family |
|
|---|---|---|
| Deductible (Calendar year) |
$5,000/$10,000 | $10,000/$20,000 |
| Coinsurance Max (Calendar year) |
$0/$0 | $2,000/$4,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$5,000/$10,000 | $12,000/$24,000 |
| Coinsurance % for most covered services | 0% | 20% |
| First Dollar Routine Care Coverage ($500 first dollar coverage) | ||
| Routine Mammograms | Covered @ 100% | 40% |
| Routine Pap Smears | Covered @ 100% | 40% |
| Routine Immunizations | Covered @ 100% | 40% |
| Coinsurance % for maternity benefits* | Not Covered (unless added as an optional benefit) | |
| Mental illness/substance abuse treatment | Not Covered (including prescription drugs) | |
| Prescription Drug Coverage | No cost after deductible (medical plan deductible applies) | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family |
Out of Network Single/Family |
|
|---|---|---|
| Deductible (Calendar year) |
$2,500/$5,000 | $5,000/$10,000 |
| Coinsurance Max (Calendar year) |
$0/$0 | $2,000/$4,000 |
| Total out-of-pocket (Deductible + coinsurance max; no copays) |
$2,500/$5,000 | $7,000/$14,000 |
| Coinsurance % for most covered services | 0% | 20% |
| First Dollar Routine Care Coverage ($500 first dollar coverage) | ||
| Routine Mammograms | Covered @ 100% | 40% |
| Routine Pap Smears | Covered @ 100% | 40% |
| Routine Immunizations | Covered @ 100% | 40% |
| Coinsurance % for maternity benefits* | Not Covered (unless added as an optional benefit) | |
| Mental illness/substance abuse treatment | Not Covered (including prescription drugs) | |
| Prescription Drug Coverage | No cost after deductible (medical plan deductible applies) | |
| Total contract benefit maximum | $10 million per covered person | |
| In Network Single/Family |
Out of Network Single/Family |
|
|---|---|---|
| Deductible (Calendar year) |
$1,500/$3,000 | $3,000/$6,000 |
| Coinsurance Max (Calendar year) |
$0/$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 ($500 first dollar coverage) | ||
| Routine Mammograms | Covered @ 100% | 40% |
| Routine Pap Smears | Covered @ 100% | 40% |
| Routine Immunizations | Covered @ 100% | 40% |
| Coinsurance % for maternity benefits* | Not Covered (unless added as an optional benefit) | |
| Mental illness/substance abuse treatment | Not Covered (including prescription drugs) | |
| Prescription Drug Coverage | No cost after deductible (medical plan deductible applies) | |
| Total contract benefit maximum | $10 million per covered person | |
