Monthly premium

356.72
BlueCHiP Direct 2300/4600
medical
2022
Gold
https://www.bcbsri.com/individual/shop/medical/2022/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 provider (PCP) directs most of your care and referrals to other doctors. This plan covers office visits and generic drugs before the deductible, and it uses our local RI network, which includes all Rhode Island hospitals.

  • Full coverage for many preventive services, like an annual physical, when you use a doctor in the network
  • MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases count toward your deductible*
  • No-cost dental exam and cleaning for members under 19
  • Earn up to $250 (both subscriber and spouse) in wellness rewards
  • Member discounts with Blue 365 on gyms, nutrition services, fitness trackers, and more health and lifestyle brands
  • $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • This plan uses our RI network, which includes all Rhode Island hospitals, 1,300+ primary care doctors, and 3,500 specialty doctors
  • View benefit information on myBCBSRI

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)

$15

PCP not affiliated with a PCMH

$35

Doctors Online (designated telemedicine provider)

$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 (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)

$25

Tier 3 (Preferred Brand)

$50 after deductible

Tier 4 (Non-Preferred Brand)

$75 after deductible

Tier 5 (Specialty)

$125 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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