Blue Cross® Preferred HMO Gold
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Individual Deductible | $850.00 |
| Family Deductible | $1,700.00 |
| Individual Out of Pocket Max | $8,500.00 |
| Family Out of Pocket Max | $17,000.00 |
| Primary Care Visit: | $30.00 |
| Specialist Visit: | $50 Copay after deductible |
| Emergency Room: | $250 Copay after deductible and 20% Coinsurance after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | https://www.bcbsm.com/content/dam/public/marketplace/2021-individual/sbc/preferred-gold-sbc.pdf |
| Plan Brochure: | https://www.bcbsm.com/index/plans/michigan-health-insurance/2021/gold/preferred-hmo.html |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $4 Copay after deductible |
| Non-Preferred Brand Drugs: | $150 Copay after deductible |
| Preferred Brand Drugs: | $100 Copay after deductible |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Summary of Benefits | https://www.bcbsm.com/2021selectdruglist |
This Carrier Offers:
About The Carrier
Blue Care Network of Michigan is a nonprofit mutual insurance company founded in 1939 .The largest health insurer in Michigan, serving 4.5 million people here and 1.6 million more in other states and the largest network of doctors and hospitals in Michigan: 152 hospitals, and more than 33,000 doctors and an independent licensee of the Blue Cross and Blue Shield Association
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