Blue Cross and Blue Shield of RI

(401) 459-5550, or 1-855-690-2583 (my0blue)

Monday - Friday, from 8:00 a.m. - 5:00 p.m.

Blue Cross and Blue Shield of RI

Medical Plan

Getting coverage is fast and easy. Add a medical plan today!

First, let’s make sure you’re in the right place.

Please read the four statements below. If any of them cover your situation, click “yes” and we’ll send you to the enrollment form. If none of them apply to you, click “no” and you can continue with the plan change form.

  • I want to add medical or dental coverage to my existing plan.
  • I need to add or remove dependents from my current plan.
  • I enrolled through HealthSource RI.
  • I am a dependent on someone else's plan, but now I need my own.

Who will be covered

Monthly Premium


Dental Plan

Getting coverage is fast and easy. Add a dental plan today!

Who will be covered

Monthly Premium


Effective Date

01/01/2018

Monthly Premium

New to Blue? Just changing your current plan? Enter some basic information so we can provide you with a quote.

I would like coverage for . I am . interested in plans. want to (edit)

Already started an enrollment form? Continue here.

Need help picking a plan?

Answer a few questions and we'll make a few recommendations.

Need help picking a plan?

Answer a few questions and we'll make a few recommendations.

Find Plans for Me

2017

Gold

2017 VantageBlue Direct 1200/2400 with Dental

This plan gives you the highest levels of medical and dental coverage. You will have access to our national network of doctors, dentists, 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, dental exam, xrays, and cleanings.
  • Includes dental and vision coverage for dependents under the age of 19
  • $2 copayments for certain prescription drugs used to treat diabetes, asthma and chronic obstructive pulmonary disorders (COPD)
  • $0 copayments for an annual foot and eye exam for members with diabetes
  • $0 copayments for programs on quitting smoking, and managing conditions like asthma and diabetes
  • Earn up to $250 (subscriber and covered spouse) in wellness rewards and receive a 20% discount on thousands of CVS branded health items
  • 24/7 phone access to care through the Nurse Care Line
  • View benefit information on Your Blue Touch RI mobile app

Who will be covered

Selecting this plan will add coverage for .


VantageBlue Direct 1200/2400 with Dental

Monthly Premium

Get Quote

356.21
VantageBlue Direct 1200/2400 with Dental
medical
2017
3
shop-for-plan/2017/vantageblue-direct-12002400-with-dental

Individual

Deductible

$1,200

Max Out-of-Pocket

$3,800

Family

Deductible

$2,400

Max Out-of-Pocket

$7,600




Deductibles

In-network

Individual

$1,200

Family

$2,400

Out-of-Pocket Limits

In-network

Individual

$3,800

Family

$7,600


What is covered?

COVERAGE TYPE
In-Network You Pay

Medical and Hospital Benefits

Medical Coverage


Preventive Services

$0

Primary Care Provider (PCP) Office Visit when affiliated with a Patient Centered Medical Home (PCMH)

First non preventive pcp visit free
Subsequent visits $15

PCP not affiliated with a PCMH

First non preventive pcp visit free
Subsequent visits $35

Telemedicine

$35

Retail Clinic

$50

Specialist Visit

$50

Annual foot and eye exam for members with diabetes

$0

Urgent Care Center

$75

Emergency Room

$200

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

Pediatric Vision Eyeware (Dependents under 19)


Collection prescription glasses, lenses, and collection contact lenses

$0

Prescription Drug Benefits

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

COVERAGE TYPE
Dental Benefits

Dental Benefits


Exams, X-Rays, Cleanings, Palliative Treatment

$0

Fluoride, Sealants, Space Maintainers

$0 (under age 19)
Not Covered (age 19+)

Fillings, Simple Extractions, Denture Repairs, Relines, Rebasing, Periodontal Maintenance, GA/IV Sedation, Root Canals, Periodotal Services, Oral Surgery

20% after deductible

Crowns & Onlays and Prosthodontics

50% after deductible

Medically Necessary Orthodontics

50% after deductible (under age 19)

Not Covered (age 19+)

I would like coverage for .
My household income is per year and there is/are person/people in my household.

No thanks, I prefer not to answer these tax questions.

Based on your responses, it appears you may qualify for a tax subsidy.

Assistance is available if you need help with the calculator.

Based on your responses, it appears you don’t qualify for a tax subsidy.