BlueSolutions for HSA Direct 3000 *

Kim, a 40-year-old consultant

Kim works on contract and does not have access to an employer health plan.

Health status:
Healthy, but has asthma.

Exercise:
Runs 4-5 days a week and occasionally competes in 5Ks.

Healthcare utilization:
Annual well visit; Routine lab work; Annual mammogram; Annual gynecological exam; One allergist visit; Two monthly tier 2 asthma inhaler medications.

Costs &
Incentives
BlueSolutions for HSA
Direct 3000
Medical Costs
Annual Well Visit with lab work,
mammogram, and gyn exam
No cost
1 visit with the Allergist $230**(applies to deductible)
Pharmacy Costs  
Tier 2 asthma inhaler medications $2,832 annually (applies to deductible)
$236/month**
Monthly Premium $277.25 (Preferred)
$400.12 (Basic)
Annual Premium $3,327.00 (Preferred)
$4,801.44 (Basic)
Wellness Reward – 10% N/A
Wellness Incentive N/A
TOTAL Estimated Annual Cost with Insurance $6,389.00 (Preferred)
$7,863.44 (Basic)

* The example provided above is only a summary of benefits provided by the plan based on the hypothetical circumstances of the participant. Other exceptions, reductions, and limitations may also apply to your benefits. The preferred premium described above is for individuals or families who satisfy certain plan requirements, and the basic premium is for participants who do not satisfy those requirements. Your actual premium will be determined based on your application answers and the results of our medical underwriting. For complete benefit details, please see the subscriber agreement for the plan.

**As a BCBSRI member, you benefit from discounts we negotiate with our in-network providers. This means that when you need care, providers charge you less than what they would charge you if you did not have health insurance with BCBSRI. These payments are your anticipated copayment as a percent of the provider’s negotiated charge.

 

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