BlueDirect Plan

Affordable high-deductible plan you can use with an HSA

Special Enrollment

Consider this plan if:

You are comfortable managing your own health care expenses before your insurance coverage begins. To pay your expenses, you can put money aside in a tax-protected HSA, which you set up separately.

Coverage available for:

Individual
Families

Plan features

Qualified high deductible health plans (HDHP) give you more control over how, where and when you spend your health care dollars
A combination of cost sharing options gives you ways to control premium costs
Wellness rewards to keep you healthy
Covers the 10 essential health benefits

Plan highlights

Can be used with a health savings account (HSA)
Free preventive visits
Extensive provider network
HealthyBlue online wellness center and rewards for managing your health

Gold Plan

Silver Plans

Bronze Plan

BlueDirect 90 2600

BlueDirect 80 3500

BlueDirect 80 3000

BlueDirect 100 6800

All cost sharing amounts apply to covered services you receive within the Preferred Blue PPO network. Covered services received out-of-network are paid at a lesser benefit or no benefit amount.
For a gold family plan, the entire family deductible must be met before coinsurance begins. The deductible can be met by one family member or all members.
For a silver or bronze family plan, an individual on the plan must meet the individual deductible before coinsurance begins.
Drug formularies and drug listings are reviewed on an ongoing basis and subject to change.
*After deductible is met

Deductible

Individual: $2,600
Family: $5,200

Individual: $3,500
Family: $7,000

Individual: $3,000
Family: $6,000

Individual: $6,800
Family: $13,600

Coinsurance

10% of total cost*

20% of total cost*

0% of total cost*

Out-of-Pocket Maximums

Individual: $4,300
Family: $8,600

Individual: $7,000
Family: $14,000

Individual: $6,800
Family: $13,600

Preventive Visits

HealthyBlue Online Wellness

Doctor Visits

10% of total cost*

20% of total cost*

0% of total cost*

Chiropractic Care, Physical, Speech and Occupational Therapy

10% of total cost*

20% of total cost*

0% of total cost*

Prescription Drugs

*Preventive Drug: $5
Preferred Generic: 10% of total cost*
Non-Preferred Generic: 10% of total cost*
Preferred Brand: 10% of total cost*
Non-Preferred Brand: 10% of total cost*
Preferred Specialty: 20% of total cost*
Non-Preferred Specialty: 50% of total cost*

Preventive Drug: $5
Preferred Generic: 20% of total cost*
Non-Preferred Generic: 20% of total cost*
Preferred Brand: 20% of total cost*
Non-Preferred Brand: 20% of total cost*
Preferred Specialty: 30% of total cost*
Non-Preferred Specialty: 50% of total cost*

Preventive Drug: $5
Preferred Generic: 0% of total cost*
Non-Preferred Generic: 0% of total cost*
Preferred Brand: 0% of total cost*
Non-Preferred Brand: 0% of total cost*
Preferred Specialty: 0% of total cost*
Non-Preferred Specialty: 0% of total cost*

Emergency Room Visit

10% of total cost*

20% of total cost*

0% of total cost*

Hospitalization

10% of total cost*

20% of total cost*

0% of total cost*

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