Monthly premium

406.79
VantageBlue Direct 1500/3000
medical
2022
Gold
https://www.bcbsri.com/individual/shop/medical/2022/vantageblue-direct-15003000-directonly

Who will be covered

Selecting this plan will add coverage for :

Gold

VantageBlue Direct

1500/3000

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, when you use a doctor in the national network
  • MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases count toward your deductible*
  • Includes dental and vision coverage for dependents under the age of 19
  • $2 copays for certain prescription drugs used to treat diabetes, asthma, and chronic obstructive pulmonary disorders (COPD)
  • $0 copays for an annual foot and eye exam for members with diabetes
  • $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • 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
  • 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)

$20 (First sick visit is free)

PCP not affiliated with a PCMH

$30 (First sick visit is free)

Doctors Online (designated telemedicine provider)

$30

Retail Clinic

$45

Specialist Visit

$45

Acupuncture Treatment

$45 (12 visits per year)

Annual foot and eye exam for members with diabetes

$0

Urgent Care Center

$75

Emergency Room

$200

Diagnostic Laboratory Tests

20% after deductible

X-rays

20% after deductible

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

20% after deductible

Inpatient Hospital

20% 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)

$25

Tier 3 (Preferred Brand)

$50

Tier 4 (Non-Preferred Brand)

$75

Tier 5 (Specialty)

$125

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

$2

*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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