Off exchange Blue Shield Silver 70 1850 PPO Details

Benefits in blue: Subject to a deductible

Benefits in black: Not subject to a deductible

The following benefits are for in-network services only. Before selecting a plan we recommend reviewing the plan’s Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) documents for specific costs and out-of-network benefits for PPO plans. There may be variations between plans that are not reflected here.

Standard Benefits for Individuals

Key benefits
Silver 70 1850 PPO
Individual Deductible
$1,850 (medical deductible)
$250 (pharmacy deductible)
Family Deductible
$3,700(medical deductible)
$500 (pharmacy deductible)
Preventative Care Copay
no cost
Primary Care Visit Copay
You pay $45
Specialty Care Visit Copay
You pay $70
Urgent Care Visit Copay
You pay $45
Lab Testing Copay
You pay 30%
X-Ray Copay
You pay 30%
Emergency Room Copay
You pay 30%
High cost and infrequent services (e.g. Hospital Stay)
You pay 30%
Tier 1 (most generics) Drug Copay
You pay $15
Tier 2 (preferred brand) Drug Copay
You pay $50
Tier 3 (non-preferred brand) Drug Copay
You pay $70
Tier 4 (specialty drugs)
You pay 30%
up to $250 per prescription
Maximum Out-of-Pocket For One
Maximum Out-of-Pocket For Family