Bronze

BasicBlue Direct

6850/13700

A plan that covers office visits and generic drugs before the deductible while also providing comprehensive coverage after you meet the deductible. You have access to our national network of doctors, labs, and hospitals, with no referral required.

  • Provides coverage for most office visits and generic drugs before deductible
  • Access to 90 percent of doctors and hospitals across 50 states
  • Certain over-the-counter preventive medications are FREE when purchased at a participating pharmacy with a prescription
  • Earn up to $250 (both subscriber and covered spouse) in wellness rewards and receive a 20% discount on CVS branded health items
  • Free dental exam, cleaning and annual exam for members under 19
  • View benefit information on Your Blue Touch RI mobile app
  • Full coverage for many preventive services, like an annual physical
  • $0 copayments for programs on quitting smoking, weight loss, and managing conditions like diabetes

Monthly premium

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248.15
BasicBlue Direct 6850/13700
medical
2018
Bronze
https://www.bcbsri.com/individual/shop/medical/2018/basicblue-direct-685013700

Who will be covered

Selecting this plan will add coverage for :

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What's covered

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Medical & Hospital Benefits

Coverage

In-Network You Pay

Medical Coverage

Preventive Services

$0

Primary Care Provider (PCP) Office Visit when affiliated with a Patient Centered Medical Home (PCMH)

$30

PCP not affiliated with a PCMH

$50

Telemedicine

$40

Retail Clinic

$50

Specialist Visit

$60

Urgent Care Center

$0 after deductible

Emergency Room

$0 after deductible

Diagnostic Laboratory Tests

$0 after deductible

X-rays

$0 after deductible

High End Radiology (i.e., MRI, PET, and CAT scans etc.)

$0 after deductible

Inpatient Hospital

$0 after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

$0 after deductible

Pediatric Dental (Dependent under 19)

Oral exams, cleanings, x-rays, fluoride treatments, sealants and space maintainers

$0

All other covered dental services 

0% after deductible

Prescription Drug Benefits

Coverage

In-Network You Pay

Tier 1 (Preferred Generic)

$10

Tier 2 (Non-preferred Generic)

$50

Tier 3 (Preferred Brand)

$0 after deductible

Tier 4 (Non-Preferred Brand)

$0 after deductible

Tier 5 (Specialty)

$0 after deductible

Monthly premium is an estimate based on the information you provided, and is not guaranteed. Your monthly premium is subject to change based on the benefits you select, the information you submit in your application, and other relevant factors.

This information is only a summary of benefits provided by the plan. It is not a contract. Other exceptions, reductions and limitations may also apply to your benefits. For details about coverage, please see the subscriber agreement for the plan or contact our Customer Service.

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622 George Washington
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