Blue Saver Silver EPO - 46944AL0710001 Health Insurance Plan

Blue Cross and Blue Shield of Alabama health insurance plan with the Plan ID 46944AL0710001. The plan is called Blue Saver Silver EPO.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.04% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.96% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 46944AL0710001
Health Insurance Plan Year 2025
State Alabama
Health Insurance Issuer Blue Cross and Blue Shield of Alabama
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 46944AL0710001-00
Provider Network(s) TIER-ONE
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Alabama All US States
All 27649 122611
PCP 3636 5382
Allergy 11 12
OB/GYN 115 170
Dentists 1163 23685
Available Variants of the Health Plan

Standard Off Exchange Plan - 46944AL0710001-00

Standard On Exchange Plan - 46944AL0710001-01

Open to Indians below 300% FPL - 46944AL0710001-02

Open to Indians above 300% FPL - 46944AL0710001-03

73% AV Silver Plan - 46944AL0710001-04

87% AV Silver Plan - 46944AL0710001-05

94% AV Silver Plan - 46944AL0710001-06

Last Plan Update Date Wed, 18 Sep 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Blue Saver Silver EPO Health Insurance Plan, 46944AL0710001-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

25.00% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing

Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

25.00% Coinsurance after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child

Benefits are available up to the end of the month in which the member turns 19.

YES

25.00% Coinsurance after deductible

100.00%
Chemotherapy
YES

25.00% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 15.0 Visit(s) per Year

YES

25.00% Coinsurance after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

25.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

Benefits are available up to the end of the month in which the member turns 19.

YES

No Charge

100.00%
Diabetes Education

Limit: 10.0 Hours per Year

Limited to 2 hours per year after initial 12-month educational period.

YES

25.00% Coinsurance after deductible

100.00%
Dialysis
YES

25.00% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

25.00% Coinsurance after deductible

100.00%
Emergency Room Services

Physician charges may apply.

YES

40.00% Coinsurance after deductible

40.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

25.00% Coinsurance after deductible

25.00% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Benefits are available up to the end of the month in which the member turns 19.

YES

25.00% Coinsurance after deductible

25.00% Coinsurance after deductible
Gender Affirming Care

Exclusions: Excludes services deemed as cosmetic.

YES

25.00% Coinsurance after deductible

100.00%
Generic Drugs

Up to a 90-day supply

YES

$5.00

100.00%
Habilitation Services

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

25.00% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services
YES

25.00% Coinsurance after deductible

100.00%
Hospice Services
YES

25.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

25.00% Coinsurance after deductible

100.00%
Infertility Treatment

Exclusions: Excludes Assisted Reproductive Technology

YES

$90.00

100.00%
Infusion Therapy
YES

25.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

25.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

25.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

25.00% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

Benefits are available up to the end of the month in which the member turns 19.

YES

50.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Inpatient Services
YES

25.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

$90.00

100.00%
Non-Preferred Brand Drugs

Up to a 90-day supply

YES

25.00% Coinsurance after deductible

100.00%
Nutritional Counseling
NO
Orthodontia - Adult
NO
Orthodontia - Child

Benefits are available up to the end of the month in which the member turns 19.

YES

50.00% Coinsurance after deductible

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)

Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

$10.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

25.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

25.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services

Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

25.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs

Up to a 90-day supply; Covered insulins limited to a $99 member cost share per 30-day supply

YES

25.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
YES

25.00% Coinsurance after deductible

100.00%
Preventive Care/Screening/Immunization

A referral is required if the service is not rendered by the member's designated primary care physician in the Blue High Performance Network, except for immunizations rendered by a pharmacy in the Pharmacy Vaccine Network.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

This plan requires each member to designate and use a primary care physician in the Blue High Performance Network.

YES

$10.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

25.00% Coinsurance after deductible

100.00%
Radiation
YES

25.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

25.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

25.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

25.00% Coinsurance after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

Benefits are available up to the end of the month in which the member turns 19.

YES

25.00% Coinsurance after deductible

100.00%
Routine Foot Care
NO
Skilled Nursing Facility
NO
Specialist Visit

Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

$90.00

100.00%
Specialty Drugs

Up to a 30-day supply

YES

25.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

25.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

$90.00

100.00%
Transplant

Limited to Blue Distinction Centers for Transplant Network

YES

25.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Exclusions: Dental related services

Limited to Phase I services. Each member must have a referral from their designated primary care physician in the Blue High Performance Network for benefits to be covered.

YES

25.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

$10.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care

This plan requires each member to designate and use a primary care physician in the Blue High Performance Network.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

25.00% Coinsurance after deductible

100.00%

Blue Saver Silver EPO Health Insurance Plan Variant 46944AL0710001-00 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Silver Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID ALF018
Formulary URL URL
HIOS Product ID 46944AL071
Import Date 2024-09-18 01:01:22
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer Actuarial Value 70.04%
Issuer ID 46944
Issuer Marketplace Marketing Name Blue Cross and Blue Shield of Alabama
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network Yes
Network ID ALN003
Out of Country Coverage Yes
Out of Country Coverage Description If a PPO provider is used, same benefits as PPO in country apply. If a non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 46944AL0710001-00
Plan Marketing Name Blue Saver Silver EPO
Plan Type EPO
Plan Variant Marketing Name Blue Saver Silver EPO
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,300
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $3,200
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $600
SBC Scenario, Having Diabetes, Deductible $300
SBC Scenario, Having Diabetes, Limit $40
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ALS004
Source Name HIOS
Specialist Requiring a Referral All specialists seen in an office setting, excluding OB/GYN, Urgent Care, and Behavioral Health.
Plan ID 46944AL0710001
State Code AL
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $6400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $3200 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $3,200
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,200
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Blue Saver Silver EPO Health Insurance Plan, 46944AL0710001

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Blue Saver Silver EPO, 46944AL0710001 Health Insurance Plan, 46944AL0710001

  • Does Blue Saver Silver EPO Health Insurance Plan, 46944AL0710001 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (46944AL0710001) Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does (46944AL0710001) Health Insurance Plan, Variant (46944AL0710001-00) have Out Of Country Coverage?

    Yes. Details: If a PPO provider is used, same benefits as PPO in country apply. If a non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.

    Does (46944AL0710001) Health Insurance Plan, Variant (46944AL0710001-00) have Out of Service Area Coverage?

    Yes. Details: If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.

    Does (46944AL0710001) Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does Blue Saver Silver EPO Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs for Asthma?

    Yes, the Blue Saver Silver EPO Health Insurance Plan Variant 46944AL0710001-00 offers Disease Management Program for Asthma.

    Does Blue Saver Silver EPO Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs for Heart disease?

    Yes, the Blue Saver Silver EPO Health Insurance Plan Variant 46944AL0710001-00 offers Disease Management Program for Heart disease.

    Does Blue Saver Silver EPO Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs for Diabetes?

    Yes, the Blue Saver Silver EPO Health Insurance Plan Variant 46944AL0710001-00 offers Disease Management Program for Diabetes.

    Does Blue Saver Silver EPO Health Insurance Plan, Variant (46944AL0710001-00) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Saver Silver EPO Health Insurance Plan Variant 46944AL0710001-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API