Monthly premium

347.52
BlueCHiP Direct 2300/4600
medical
2019
Gold
https://www.bcbsri.com/individual/shop/medical/2019/bluechip-direct-23004600-directonly

Who will be covered

Selecting this plan will add coverage for :

Gold

BlueCHiP Direct

2300/4600

This is the lowest cost plan that Blue Cross offers in the gold tier. Your primary care physician directs most of your care and referrals to other doctors. This plan covers office visits and generic drugs before the deductible, and uses our local RI network, which includes all Rhode Island hospitals.

  • Full coverage for many preventive services, like an annual physical
  • Free dental exam, cleaning and annual exam for members under 19
  • Earn up to $250 (both subscriber and spouse) in wellness rewards and receive a 20% discount on thousands of CVS branded health items
  • $0 copayments for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • This plan uses our RI network, which includes all Rhode Island hospitals, 1,550 primary care doctors, and 3,800 specialty doctors

What's covered

See if your doctor is in the network
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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)

$15

PCP not affiliated with a PCMH

$35

Telemedicine

$35

Retail Clinic

$45

Specialist Visit

$45

Acupuncture Treatment

$45 (12 visits per year)

Urgent Care Center

$75

Emergency Room

10% after deductible

Diagnostic Laboratory Tests

10% after deductible

X-rays

10% after deductible

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

10% after deductible

Inpatient Hospital

10% after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

10% after deductible

Pediatric Dental (Dependent under 19)

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

$0

All other covered dental services 

50% after deductible

Prescription Drug Benefits

Coverage

In-Network You Pay

Tier 1 (Preferred Generic)

$10

Tier 2 (Non-preferred Generic)

$25

Tier 3 (Preferred Brand)

$50 after deductible

Tier 4 (Non-Preferred Brand)

$75 after deductible

Tier 5 (Specialty)

$125 after deductible

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 Hwy
Visit Your Blue Store
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