Plan availability |
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County of residence |
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Exchange |
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HSA Eligible |
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Plan details |
You pay |
Deductible (individual / family)Medical and prescription drug |
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Out-of-pocket max |
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Coinsurance |
Doctor visits |
You pay |
Primary care office visit |
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Specialist office visit |
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VirtualCare PCP visit (Delivered via the Capital Blue Cross Virtual Care platform) |
Emergencies |
You pay |
Emergency room |
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Urgent care |
Tests and lab work |
You pay |
Diagnostic lab services |
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Outpatient diagnostic test (X-ray) |
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Outpatient high tech imaging |
Hospital services |
You pay |
Outpatient surgery service |
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Inpatient hospital admission |
Prescriptions |
You pay |
Retail Rx |
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Home delivery Rx |
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Formulary |
Plan details |
You pay |
Routine dental check-up adult |
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Routine dental check-up child |
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Deductible adult |
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Deductible child |
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Out-of-pocket max adult |
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Out-of-pocket max child |
Plan details |
Children |
Adults |
Diagnostic and preventative services |
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Basic services |
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Major services |
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Orthodontia services |
Children- under age 19
Adults- age 19 and over
Plan details |
You pay |
Routine eye exam |
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Frames |
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Contact Lenses(Instead of glasses) |
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Other add-ons |
1All other brand names, product names, or trademarks belong to their respective holders.
2Discounts are not insurance and create no liability for payment by the plan.