Silver

VantageBlue Direct

4850/9700

This plan gives you the highest levels of coverage and flexibility to choose what doctors you see. You will have access to our national network of doctors (across all 50 states), labs, and hospitals, with no referral required.

  • Provides coverage for most office visits before deductible
  • Full coverage for many preventive services, like an annual physical
  • Includes dental and vision coverage for dependents under the age of 19
  • $2 copayments for certain prescription drugs used to treat diabetes, asthma and chronic obstructive pulmonary disorders (COPD)
  • $0 copayments for an annual foot and eye exam for members with diabetes
  • $0 copayments for programs on quitting smoking, and managing conditions like asthma and diabetes
  • Earn up to $250 (both subscriber and covered spouse) in wellness rewards and receive a 20% discount on CVS branded health items
  • View benefit information on Your Blue Touch RI mobile app

Monthly premium

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284.04
VantageBlue Direct 4850/9700
medical
2018
Silver
https://www.bcbsri.com/individual/shop/medical/2018/vantageblue-direct-48509700-directonly

Who will be covered

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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)

$40 (First sick visit is free)

PCP not affiliated with a PCMH

$60 (First sick visit is free)

Telemedicine

$40

Retail Clinic

$50

Specialist Visit

$65

Annual foot and eye exam for members with diabetes

$0

Urgent Care Center

$75

Emergency Room

$275

Diagnostic Laboratory Tests

30% after deductible

X-rays

30% after deductible

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

30% after deductible

Inpatient Hospital

30% after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

$0

Pediatric Dental (Dependent under 19)

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

$0

All other covered dental services 

50%

Prescription Drug Benefits

Coverage

In-Network You Pay

Tier 1 (Preferred Generic)

$10

Tier 2 (Non-preferred Generic)

$35

Tier 3 (Preferred Brand)

$80

Tier 4 (Non-Preferred Brand)

$100

Tier 5 (Specialty)

$250

Certain maintenance prescriptions for diabetes, asthma, and chronic obstructive pulmonary disease (COPD)

$2

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.

You want the right plan. We can help you choose.

Call (401) 459-5550 or just come by:
Warwick location
Warwick
Cowesett Corners
300 Quaker Lane
East Providence location
East Providence
Highland Commons
71 Highland Avenue
Lincoln location
Lincoln
Lincoln Mall Shopping Center
622 George Washington
Visit Your Blue Store
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