Compare health plans
Access to care highlights
PPO PLAN WITH VIRTUAL BLUE
EPO PLAN WITH VIRTUAL BLUE
HDHP PPO PLAN WITH VIRTUAL BLUE
ACCESS+ HMO PLAN
TRIO HMO PLAN
Network
Virtual + VB PPO + non-network providers
Virtual + VB PPO
Virtual + VB PPO + non-network providers
Full HMO network of providers
Select network of local providers
Access to in-person doctors, hospitals, etc.
Visit any doctor you choose
Visit any doctor in the PPO network
Visit any doctor you choose
PCP required; self-refer to specialist possible
PCP required; self-refer to specialist possible
Deductible: Individual
$500 (network + non-network)
$500
$5,000 (network + non-network)
None
None
Deductible: Family
$500: individual (network + non-network) $1,000: family (network + non-network)
$500: individual $1,500: family
$5,000: individual (network + non-network) $10,000: family (network + non-network)
None
None
Out-of-pocket maximum
In-network: Individual
$2,500
$3,500
$6,000 (network + non-network)
$1,000
$1,000
In-network: Family
$2,500: individual $5,000: family
$3,500: individual $7,000: family
$6,000: individual (network + non-network) $12,000: family (network + non-network)
$3,000
$3,000
Out-of-network: Individual
$3,500
N/A
Combined with in-network deductible
N/A
N/A
Out-of-network: Family
$3,500: individual $7,000: family
N/A
Combined with in-network deductible
N/A
N/A
Medical benefits
PPO PLAN WITH VIRTUAL BLUE
(colspan-2)
EPO PLAN WITH VIRTUAL BLUE
HDHP PPO PLAN WITH VIRTUAL BLUE
(colspan-2)
ACCESS+ HMO PLAN
TRIO HMO PLAN
Costs per office visit / admission
In-network
Out-of-Network
In-network
In-network
Out-of-Network
In-network
In-network
Preventive health exam
$0
50%*
$0
$0
Not covered
$0
$0
Virtual Blue virtual providers: PCP/specialist visit
$0
N/A
$0
$0
N/A
N/A
N/A
Primary Care visit
$25
50%*
$25
20%*
50%*
$25
$25
Specialist visit
$35
50%*
$35
20%*
50%*
$25
$25
Specialist office visit (HMO self-referral)**
N/A
N/A
N/A
N/A
N/A
$35
$35
Prenatal and postnatal visit
$25
50%*
$25
20%*
50%*
$25
$25
Virtual Blue virtual providers: mental health
$0
50%
$0
$0
N/A
$0
$0
Mental health visit
$0
50%
$0
20%*
50%*
$0
$0
Mental health outpatient services
$0*
50%
$0*
$0*
50%*
$0
$0
Substance abuse outpatient services
$0*
50%
$0*
20%*
50%*
$0
$0
Substance abuse inpatient facility
$500 + 20%*
50%*
$500 + 20%*
$100 + 20%*
50%*
$500
$500
Lab work
$0
50%
$25
20%*
50%*
$25
$25
Outpatient surgery (facility services)
$0*
$500 + 50% (max benefit: $2,000 per day)*
$250*
20%*
50% (max benefit: of $350/day)*
$0
$0
Inpatient hospital services and stay
$500 + 20%*
$500 + 50% (max benefit: $2,000 per day)*
$500 + 20%*
$100 + 20%*
50%* (max benefit of $600/day)
$500 / admission
$500 / admission
Urgent care services
$25
50%*
$25
20%*
50%*
$25
$25
Emergency room services
$125 +20%
$125 +20%
$125 + 20%
$150 + 20%*
$150 + 20%*
$125
$125
Acupuncture services
$25
50%*
$25
20%*
50%*
$15
$15
Chiropractic services
$25
50%*
$25
20%*
50%*
$15
$15
Pharmacy benefits
PPO PLAN WITH VIRTUAL BLUE
(colspan-2)
EPO PLAN WITH VIRTUAL BLUE
HDHP PPO PLAN WITH VIRTUAL BLUE
(colspan-2)
ACCESS+ HMO PLAN
TRIO HMO PLAN
Costs per fill
In-network
Out-of-Network
In-network
In-network
Out-of-Network
In-network
In-network
Pharmacy deductible
None
None
None
Combined with medical
Combined with medical
None
None
RETAIL (30-day supply / prescription)
Contraceptive drugs/devices
$0
Cost based on tier
$0
$0
Cost based on tier
$0
$0
Preventive drugs (value-based or HDHP)
$0
Not covered
$0
$0
Not covered
$0
$0
Tier 1 drugs
$10
$10 + 25% of cost
$10
$10*
$10 + 25% *
$10
$10
Tier 2 drugs
$25
$25 + 25% of cost
$25
$25*
$25 + 25% of cost*
$25
$25
Tier 3 drugs
$40
$40 + 25% of cost
$40
$40*
$40 + 25% of cost*
$40
$40
Tier 4 drugs
$40
$40 + 25% of cost
$40
$40*
$40 + 25% of cost*
$40
$40
MAIL-SERVICE (90-day supply / prescription)
Contraceptive drugs/devices
$0
Not covered
$0
$0
Not covered
$0
$0
Preventive drugs (value-based or HDHP)
$0
Not covered
$0
$0
Not covered
$0
$0
Tier 1 drug
$20
Not covered
$20
$20*
Not covered
$20
$20
Tier 2 drugs
$50
Not covered
$50
$50*
Not covered
$50
$50
Tier 3 drugs
$80
Not covered
$80
$80*
Not covered
$80
$80
Tier 4 drugs
$80
Not covered
$80
$80*
Not covered
$80
$80
* Calendar-year deductible applies. This is the amount a Member pays each calendar year before Blue Shield pays for covered services under the Plan. Blue Shield pays for some covered services before the calendar year deductible is met, as noted in the benefits chart above.
** Self-referral to specialists may be available to members of participating medical groups – no need to see your primary care physician first. Please see your plan's Evidence of Coverage for more details.