BlueSolutions for HSA Direct 6000 *

Jessica, a 30-year-old waitress & Matt, a 31-year-old chef

Jessica and Matt both work at restaurants that do not offer health coverage to their employees.

Health status:
Both healthy; Matt sprains his ankle playing soccer.

Matt plays recreational soccer; Jessica uses a treadmill at home 2-3 days per week.

Healthcare utilization:
Annual well visits; Routine lab work; One emergency room visit; Two X-rays; One orthopedic visit; One generic pain medication.

Costs &
BlueSolutions for HSA Direct
Medical Costs
 Annual Well Visit,lab work,
mammogram, and gyn exam
No Cost
ER visit $560**(applies to deductible)
2-X-rays $260**(applies to deductible)
Orthopedic visit $230**(applies to deductible)
Pharmacy Costs  
Generic med $29**(applies to deductible)
Monthly Premium $540.11 (Preferred)
$710.82 (Basic)
Annual Premiums $6,481.32 (Preferred)
$8,529.84 (Basic)
Wellness Reward – 10%
Wellness Incentive N/A
TOTAL Estimated Annual Cost with
$7,560.32 (Preferred)
$9,608.84 (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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