BlueValue Direct 2500 *

Tom, a 26-year-old bartender

Tom works for a restaurant that does not offer an employer health plan.

Health status:
Healthy.

Exercise:
Works out at a gym several times a week; Plays in recreational basketball league.

Healthcare utilization:
Annual well visit; Routine lab work; One urgent care visit; One generic antibiotic prescription.
 

Your Costs &
Incentives
BlueValue Direct
2500
Medical Costs
Annual Well Visit and lab work
No cost
Urgent Care $112.50**(applies to deductible)
Pharmacy Costs $4 copay
Monthly Premium $106.11 (Preferred)
$257.42 (Basic)
Annual Premium $1,273.32 (Preferred)
$3,089.04 (Basic)
Wellness Reward – 10% N/A
Wellness
Incentive
$100 Fitness Center
Reimbursement
TOTAL Estimated Annual Cost with Insurance $1,389.82 (Preferred)
$3,205.54 (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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