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

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

2017 BlueCHiP Direct 1800/3600

This is the lowest cost plan that Blue Cross offers in the gold tier. Your primary care physician directs most of your care and referrals to other doctors. This plan covers office visits and generic drugs before the deductible, and uses our local RI network, which includes all Rhode Island hospitals.

  • Full coverage for many preventive services, like an annual physical
  • Free dental exam, cleaning and annual exam for members under 19
  • 24/7 phone access to care through the Nurse Care Line
  • Earn up to $250 (both subscriber and spouse) in wellness rewards and receive a 20% discount on thousands of CVS branded health items
  • $0 copayments for programs on quitting smoking, weight loss, and managing conditions like diabetes
  • This plan uses our local RI network, which includes all Rhode Island Hospitals, 2,110 primary care doctors, 8,235 specialty doctors

Deductibles

In-network

Individual

$1,800

Family

$3,600

Out-of-Pocket Limits

In-network

Individual

$3,600

Family

$7,200


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)

$15

PCP not affiliated with a PCMH

$25

Telemedicine

$25

Retail Clinic

$40

Specialist Visit

$40

Urgent Care Center

$75

Emergency Room

10% after deductible

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

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

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