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

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

2017 BlueSolutions for HSA Direct 6000/12000

This plan offers a high level of coverage once you meet your deductible with the added benefit of an optional health savings account to pay for medical expenses. You’ll have access to our national network of doctors (across all 50 states), labs, and hospitals.

  • Full coverage for many preventive services, like an annual physical
  • You receive tax advantages when you open a health savings account
  • Includes dental and vision coverage for dependents under the age of 19
  • $0 copayments for programs on quitting smoking, and managing conditions like asthma and diabetes
  • Earn up to $250 (both subscriber and covered spouse) in wellness rewards and receive a 20% discount on 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

Deductibles

In-network

Individual

$6,000

Family

$12,000

Out-of-Pocket Limits

In-network

Individual

$6,550

Family

$13,100


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)

$0 after deductible

PCP not affiliated with a PCMH

$0 after deductible

Telemedicine

$0 after deductible

Retail Clinic

$0 after deductible

Specialist Visit

$0 after deductible

Urgent Care Center

$0 after deductible

Emergency Room

$0 after deductible

Diagnostic Laboratory Tests

$0 after deductible

X-rays

$0 after deductible

High End Radiology (i.e., MRI, PET, and CAT scans etc.)

$0 after deductible

Inpatient Hospital

$0 after deductible

Pediatric Vision Eyeware (Dependents under 19)

Collection prescription glasses, lenses, and collection contact lenses

$0 after deductible

Pediatric Dental (Dependent under 19)

Oral exams, cleanings, x-rays, fluoride treatments, sealants and space maintainers

$0 after deductible

All other covered dental services

50% after deductible

Prescription Drug Benefits

Tier 1 (Preferred Generic)

$10 after deductible

Tier 2 (Non-preferred Generic)

$35 after deductible

Tier 3 (Preferred Brand)

$60 after deductible

Tier 4 (Non-Preferred Brand)

$100 after deductible

Tier 5 (Specialty)

$200 after deductible