Blue Cross® Premier PPO Bronze Extra
| Plan Type: | PPO |
| Plan Tier: | Expanded Bronze |
| Individual Deductible | $8,000.00 |
| Family Deductible | $16,000.00 |
| Individual Out of Pocket Max | $8,500.00 |
| Family Out of Pocket Max | $17,000.00 |
| Primary Care Visit: | $40.00 |
| Specialist Visit: | $100.00 |
| Emergency Room: | 40% Coinsurance after deductible |
| Hospital - Physician: | 40% Coinsurance after deductible |
| Hospital - Facility: | 40% Coinsurance after deductible |
| Link to Full SBC: | https://www.bcbsm.com/content/dam/public/marketplace/2021-individual/sbc/premier-bronze-extra-sbc.pdf |
| Plan Brochure: | https://www.bcbsm.com/index/plans/michigan-health-insurance/2021/bronze/premier-ppo-extra.html |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $35.00 |
| 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
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Michigan: Blue Cross Blue Shield Healthcare Plan of Michigan, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc.
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