Blue Standardized Silver - 46944AL0730001 Health Insurance Plan

Blue Cross and Blue Shield of Alabama health insurance plan with the Plan ID 46944AL0730001. The plan is called Blue Standardized Silver.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.01% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.99% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 46944AL0730001
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 46944AL0730001-00
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 - 46944AL0730001-00

Standard On Exchange Plan - 46944AL0730001-01

Open to Indians below 300% FPL - 46944AL0730001-02

Open to Indians above 300% FPL - 46944AL0730001-03

73% AV Silver Plan - 46944AL0730001-04

87% AV Silver Plan - 46944AL0730001-05

94% AV Silver Plan - 46944AL0730001-06

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

Benefits of Blue Standardized Silver Health Insurance Plan, 46944AL0730001-00

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

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Acupuncture
NO
Allergy Testing

Each member must have a referral from their designated Primary Care Select Physician for benefits to be covered.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
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

20.00%

100.00%
Chemotherapy
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Chiropractic Care

Limit: 15.0 Visit(s) per Year

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
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

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Dialysis
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Durable Medical Equipment
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Emergency Room Services

Physician charges may apply.

YES

40.00% Coinsurance after deductible

40.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

40.00% Coinsurance after deductible

40.00% 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

40.00% Coinsurance after deductible

40.00% Coinsurance after deductible
Gender Affirming Care

Exclusions: Excludes services deemed as cosmetic.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Generic Drugs

Up to a 90-day supply

YES

$20.00

100.00%
Habilitation Services

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

$40.00

60.00% Coinsurance after deductible
Hearing Aids
NO
Home Health Care Services
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Hospice Services
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Infertility Treatment

Exclusions: Excludes Assisted Reproductive Technology

YES

$80.00

60.00% Coinsurance after deductible
Infusion Therapy
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
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

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
YES

$40.00

60.00% Coinsurance after deductible
Non-Preferred Brand Drugs

Up to a 90-day supply

YES

$80.00 Copay 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 Select Physician for benefits to be covered.

YES

$40.00

60.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

$40.00

60.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services

Each member must have a referral for benefits to be covered.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Preferred Brand Drugs

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

YES

$40.00

100.00%
Prenatal and Postnatal Care
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Preventive Care/Screening/Immunization

A referral is required if the service is not rendered by the member's designated Primary Care Select Physician, except for immunizations rendered by a pharmacy in the Pharmacy Vaccine Network.

YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness

This plan requires each member to designate and use a Primary Care Select Physician.

YES

$40.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Radiation
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Reconstructive Surgery

Each member must have a referral from their designated Primary Care Select Physician for benefits to be covered.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

$40.00

60.00% Coinsurance after deductible
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

Combined maximum visits for Occupational, Physical and Speech Therapy

YES

$40.00

60.00% Coinsurance after deductible
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

40.00% 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 Select Physician for benefits to be covered.

YES

$80.00

60.00% Coinsurance after deductible
Specialty Drugs

Up to a 30-day supply

YES

$350.00 Copay after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services
YES

$40.00

60.00% Coinsurance after deductible
Transplant

Limited to Blue Distinction Centers for Transplant Network

YES

40.00% 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 Select Physician for benefits to be covered.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Urgent Care Centers or Facilities
YES

$60.00

60.00% Coinsurance after deductible
Weight Loss Programs
NO
Well Baby Visits and Care

This plan requires each member to designate and use a Primary Care Select Physician.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible

Blue Standardized Silver Health Insurance Plan Variant 46944AL0730001-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.700118579527384
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 Design 1
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID ALF102
Formulary URL URL
HIOS Product ID 46944AL073
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 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 ALN001
Out of Country Coverage Yes
Out of Country Coverage Description If PPO provider is used, same benefits as PPO in country apply. If 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 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) 46944AL0730001-00
Plan Marketing Name Blue Standardized Silver
Plan Type PPO
Plan Variant Marketing Name Blue Standardized Silver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,000
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $5,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $900
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 $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ALS001
Source Name HIOS
Specialist Requiring a Referral All specialists seen in an office setting, excluding OB/GYN, Urgent Care, and Behavioral Health.
Plan ID 46944AL0730001
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 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $10000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,000
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $20000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $10000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $10,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,000
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Blue Standardized Silver Health Insurance Plan, 46944AL0730001

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

Frequently Asked Questions(FAQ) about Blue Standardized Silver, 46944AL0730001 Health Insurance Plan, 46944AL0730001

  • Does Blue Standardized Silver Health Insurance Plan, 46944AL0730001 support Mail Ordering?

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

  • Does (46944AL0730001) Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs?

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

    Does (46944AL0730001) Health Insurance Plan, Variant (46944AL0730001-00) have Out Of Country Coverage?

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

    Does (46944AL0730001) Health Insurance Plan, Variant (46944AL0730001-00) have Out of Service Area Coverage?

    Yes. Details: If 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 (46944AL0730001) Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs?

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

    Does Blue Standardized Silver Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs for Asthma?

    Yes, the Blue Standardized Silver Health Insurance Plan Variant 46944AL0730001-00 offers Disease Management Program for Asthma.

    Does Blue Standardized Silver Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs for Heart disease?

    Yes, the Blue Standardized Silver Health Insurance Plan Variant 46944AL0730001-00 offers Disease Management Program for Heart disease.

    Does Blue Standardized Silver Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs for Diabetes?

    Yes, the Blue Standardized Silver Health Insurance Plan Variant 46944AL0730001-00 offers Disease Management Program for Diabetes.

    Does Blue Standardized Silver Health Insurance Plan, Variant (46944AL0730001-00) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Standardized Silver Health Insurance Plan Variant 46944AL0730001-00 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