Medical and Pharmacy Medical and Pharmacy

Medical Insurance

Your medical insurance, explained.

FAQs
Banner

Blue Saver 100 3200 Overview

Here are some plan highlights.

Preventive care is free

Preventive care keeps you and your family healthy. That's why the plan will cover some in-network preventive care before a deductible has been met. However, a copayment or coinsurance may apply to the visit.
  • 1
    Annual physical exams
  • 2
    Preventive health visits, lab services, and medications
  • 3
    Routine Immunizations
  • 4
    Routine diagnostic screenings

Find a doctor in our network.

We understand that finding a doctor can be stressful, so we make it easy for you. This plan uses a provider network. If you use a provider within the plan's network, you'll pay less. 
Browse Online

Or call 1-844-363-8455 for a list of network providers.

Deductible + Out of Pocket Limits

A deductible is the amount you pay for healthcare services before your insurance begins to chip in for non-preventive care.  Once you hit your plan’s Out of Pocket Limit, however, your medical plan will cover 100% of all in-network costs, and you don’t need to pay anything.

Coverage In-Network
Deductible		 In-Network
Out of Pocket Limit		Out-of-Network
Deductible		Out-of-Network
Out of Pocket Limit
Individual $3,200
 $3,200
$6,400
$12,800
1 parent + 1 child $4,800
 $4,800
$9,600
$19,200
1 parent + children $4,800
 $4,800
$9,600
$19,200
2 adults $6,400

 $6,400
$12,800
$25,600
Family $6,400
 $6,400
$12,800
$25,600

Out-of-pocket costs are the medical fees that you pay from your own pocket.  This includes your deductibles, coinsurance, and copayments for covered services, plus all costs for services that aren't covered.  Some services do not apply toward your out-of-pocket limit, including premiums, nonformulary drug sanctions, balance-billed charges and health care this plan doesn't cover.


Visiting your Doctor

How much you'll pay for an appointment in-network or out-of-network. If you need drugs to treat a condition or illness, your plan can share the cost, depending on what kind of medication it is.

Service In-Network Cost
(You will pay the least)		Out-of-Network Cost
(You will pay the most)
Primary Care visit to treat an injury or illness 0% coinsurance

20% coinsurance
Specialist Visit 0% coinsurance

20% coinsurance
Preventive Care, Immunizations & Screenings No charge
Not covered.  You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
Preventive Medication No Charge (retail & mail order)
No Charge (retail & mail order)
Formulary Medications 0% coinsurance (retail & mail order)
0% coinsurance (retail & mail order)
Non-formulary Medications 50% sanction (retail & mail order)
50% sanction (retail & mail order)
Speciality Medications 0% coinsurance (formulary) 50% sanction (nonformulary)
0% coinsurance (formulary)
50% sanction (nonformulary)


Other Services

Mental Health

Your mental and emotional health is important to us. Your plan has coverage options for both inpatient and outpatient care. 

Inpatient care covers services like talk counseling, group therapy, medical consultations, and psychiatry. 
  • In-Network: 0% coinsurance after deductible
  • Out-of-Network: 20% coinsurance after deductible

    Outpatient care offers 24-hour care in a safe and secure facility, making it best for patients with severe mental health or substance abuse issues who require constant monitoring.
    • In-Network: 0% coinsurance/ office visit or other services after deductible
    • Out-of-Network: 20% coinsurance/ office visit or other services after deductible
    Telemedicine: Visit with a therapist or psychiatrist from the comfort and privacy of home. 
    Urgent Care

    Urgent care centers are often more affordable than the emergency room. 

    Use urgent care for non-life-threatening conditions like minor cuts, sprained ankles, bad flu, or other health issues where a doctor needs to see you right away.
    • In-Network: 0% coinsurance after deductible
    • Out-of-Network: 20% coinsurance after deductible

    Telemedicine: Consult with a provider 24/7 from the comfort and privacy of home. 
    Telemedicine

    Seeing a doctor from the comfort of your own home can be a great experience. Learn more here.

    Your plan covers telemedicine through Amwell. Cost varies depending on service and provider.

    For more information about all online services click here.

    Imaging

    Imaging and X-rays are covered at 0% coinsurance (In-Network) and 20% coinsurance (Out-of-Network) after deductible.

    Hospital and Other Fees

    Hospital and physician/surgeon fees are covered at 0% coinsurance (In-Network) and 20% coinsurance (Out-of-Network) after deductible.

      Emergency Room
      Emergency room visits/stays are coverage at 0% coinsurance (In-Network) and 0% coinsurance (Out-of-Network) after deductible.
      Emergency Transportation

      Emergency medical transportation is covered at 0% coinsurance (In-Network) and 0% coinsurance (Out-of-Network) after deductible.

      For more benefits details and coverage information, read more about your BlueSaver 100 3200 Coverage.

      Frequently asked questions

      If you don’t meet your deductible, your insurance plan will only help you pay for preventative services.

      Yes. See bcbsnd.com/find-a-doctor or call 1-844-363-8455 for a list of network providers.

      This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

      Annual physical exams, preventive lab services, routine immunizations, preventive medications, preventive health visits (both for men and women).

      Co-Insurance is the amount that you need to pay for medical services after you meet your plan’s deductible, but before you hit your out-of-pocket limit. For example, if a procedure is covered by your plan at 25% coinsurance, your plan pays 75% of the cost, and you pay the 25% coinsurance.

      A Co-Pay is a flat fee used to pay for certain medical costs, like prescriptions and some preventative care procedures.