Monthly premium
Do you qualify for Medicare + Medicaid? If so, this plan will give you the most $0 benefits that we offer. You'll also get your very own Health Navigator to answer your questions, help with paperwork and appointments, and much more.
Questions? Call us at (401) 459-5477 or 1-855-430-9293 (TTY: 711).
Not sure what plan you need? Use the plan recommendation tool.
Medical
- $0 monthly premium*
- $0 primary care visits
- $0 specialist visits
- $0 labs and X-rays
- $0 inpatient hospital stay
- $0 outpatient surgery copay
- $0 skilled nursing facility
- $0 physical/speech/occupational therapy
Prescription Drugs
- $0 prescription drugs (Tiers 1 and 2)
- $0-$12.65 prescription drugs (Tiers 3-5)***
Dental/Vision/Hearing
- $2,500/year dental benefit maximum
- $0 cost preventive and comprehensive dental
- $0 cost annual vision exam
- Get $200/year allowance for eyewear
- $0 cost annual hearing exam
- $0 cost hearing aids
Extras
- $0 access to select fitness centers across the state
- Get $151/month for groceries** and over-the-counter (OTC) everyday health items (Flexible Benefit Card)
- 60 one-way rides/year
Note: Plan does NOT have out-of-network coverage
Ambulance
$0
Dental Services
Medicare-covered:
$0
Preventive: $0
Comprehensive: $0
$2,500 limit on all covered dental services for preventive and comprehensive dental services. All preventive and comprehensive services must be provided by an in-network plan-contracted dentist.
Diabetes Supplies and Services
$0
You must use Abbott plan-designated monitors and test strips.
Diagnostic Tests, Lab and Radiology Services, and X-Rays
$0 for lab services
$0 for diagnostic tests and X-rays
$0 for high-tech radiology services (for example, MRIs)
Emergency Care
$0
Outpatient Hospital/Surgery
$0
Hearing Services
Routine hearing
$0
Non-routine hearing
$0 copay
Hearing aids
$0 per hearing aid (2 aids every year)
Primary Care Physician Visit
$0
Specialist Visit
$0
Vision Visit
Routine vision
$0
Non-routine vision
$0
Vision hardware
Our plan offers a $200/year allowance for vision hardware.
Preventive Care
$0
Inpatient Hospital Care
$0 Days 1 and beyond
Our plan covers an unlimited number of days for an in-network inpatient hospital stay.
Skilled Nursing Facility
$0 per day for days 1-100
Our plan covers up to 100 days in a skilled nursing facility.
Preferred Mail Order (100-day Supply)
Prescription Deductible
No deductible+
Tier 1 (Preferred Generic)
$0 copay
$0 copay
Tier 2 (Non-preferred Generic)
$0 copay
$0 copay
Tier 3 (Preferred Brand)
$0-$12.65 copay+
$0-$12.65 copay+
Tier 4 (Non-Preferred Drug)
$0-$12.65 copay+
$0-$12.65 copay+
Tier 5 (Specialty Tier)
$0-$12.65 copay+
N/A
Insulins (30-day supply)
$0-$12.65 copay+
Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (Open seven days a week, 8:00 a.m. to 8:00 p.m., October 1 – March 31.)You can use our automated answering system outside of these hours.
*You must qualify for Extra Help
**You may be eligible for the monthly grocery benefit, which is part of Special Supplemental Benefits (SSBCI) if you are living with one or more qualifying chronic condition(s), as defined by CMS, including but not limited to chronic heart failure, chronic lung diseases, dementia, diabetes mellitus, and frailty & fall risk. Please see your Evidence of Coverage for full details.
***You must qualify for Extra Help to receive assistance with prescription drug costs. Your cost share depends on your Extra Help level: Level 2 - $0 for all prescriptions; Level 3 - $1.60 for generics, $4.90 for brand-name drugs; Level 4 - $5.10 for generics, $12.65 for brand-name drugs. All Extra Help members pay no pharmacy deductibles.
+ Based on receiving Low Income Subsidies (LIS). If you lose your Low Income Subsidies (LIS), you will be required to pay copayments and coinsurance.
1The out-of-pocket maximum includes only Medicare-covered services. This is the most a member would pay for these services during a calendar year. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Essential (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS) BlueCHiP for Medicare Extra (HMO-POS), or the BlueCHiP for Medicare Access (HMO-POS) plan. If you select the BlueCHiP for Medicare Essential (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), or the BlueCHiP for Medicare Access (HMO-POS) plan, with the exception of emergency or urgent care, ambulance, or dialysis services, it may cost more to get care from out-of-network providers.
2A preauthorization may be required. Review may include but is not limited to pre-authorization and/or continued treatment by the plan and/or plan designee. Contact Plan for details.
3You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances, quantity limitations and restrictions may apply. Please refer to the Summary of Benefits or the Evidence of Coverage for prescription drug cost share information in a long-term care setting, mail order and extended day retail supplies as well as detailed benefit information concerning the Initial Coverage stage and the Catastrophic level stage.