|
|
Blue Options FC eligible plans
| |
Series 1 |
Series 2 |
Series 3 |
Series 4 |
Series 5 |
Series 6 |
| Copayments |
$10/$20
or
$15/$30
|
$10/$20
or
$20/$30
|
$15/$30
or
$20/$40
|
$15/$30
or
$20/$40
|
$15/$30
or
$25/$50 |
N/A |
| Deductibles |
$250
or
$500 |
$500
or
$1000 |
$500
or
$1000 |
$1000
or
$2500 |
$1000
or
$2500 |
$2500
or
$5000 |
| Coinsurance |
100%/80%
or
80%/70% |
90%/70%
or
80%/70% |
80%/70%
or
60%/40% |
80%/70%
or
60%/40% |
60%/40% |
80%/60%
or
50%/50% |
| Prescription drugs |
$5/$15/$30
or
$10/60% |
$10/$20/$35
or
$10/60% |
$10/$20/$35
or
$10/50% |
$10/$25/$40
or
$10/50% |
$10/$35/$50
or
$10/25% |
$10/$45/$60
or
$10/25% |
| Coinsurance maximum |
$0/$1,000 |
$2,000 |
$2,000 |
$3,000 |
$3,000 |
$3,000 |
| Number of combinations |
16 |
16 |
16 |
16 |
8 |
8 |
|