Monthly premium

297.54
BasicBlue Direct 5500/11000
medical
2022
Silver
https://www.bcbsri.com/individual/shop/medical/2022/basicblue-direct-550011000-directonly

Who will be covered

Selecting this plan will add coverage for :

Silver

BasicBlue Direct

5500/11000

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 95% of doctors and hospitals across 50 states
  • MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases count toward your deductible*
  • Certain over-the-counter preventive medications cost $0 when purchased at a participating pharmacy with a prescription
  • Earn up to $250 (both subscriber and covered spouse) in wellness rewards
  • Member discounts with Blue 365 on gyms, nutrition services, fitness trackers, and more health and lifestyle brands
  • Free dental exam and cleaning for members under 19
  • View benefit information on myBCBSRI
  • Full coverage for many preventive services, like an annual physical, when you use a doctor in the national network
  • $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes

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)

$10

PCP not affiliated with a PCMH

$20

Doctors Online (designated telemedicine provider)

$20

Retail Clinic

$45

Specialist Visit

$45

Acupuncture Treatment

$45 after deductible (12 visits per year)

Urgent Care Center

$75 after deductible

Emergency Room

10% after deductible

Diagnostic Laboratory Tests

10% after deductible

X-rays

10% after deductible

High-End Radiology (for example, MRI, PET, and CAT scans)

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)

$30

Tier 3 (Preferred Brand)

$50 after deductible

Tier 4 (Non-Preferred Brand)

$75 after deductible

Tier 5 (Specialty)

$100 after deductible

*MedsYourWay is not insurance. It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services. Ask your pharmacy if they participate in MedsYourWay before filling your prescription.

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