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BlueChoices BlueBasic Coinsurance - $7,500 Deductible

Health Insurance Utah | Individual BlueChoices BlueAdvantage Coinsurance - $7,500 Deductible

    • Higher deductibles mean your rates are more affordable.
    • Prescriptions covered after you meet your medical deductible.
    • Preventive care covered for all ages.

Coverage at a Glance


Deductible:
Annual OOP Max: $10,000 per member, $18,000 per family
Lifetime Max: $2 million per member
Copay: Not applicable on this plan
Coinsurance: 30% contracted providers, 45% non-contracted
Coinsurance Max: Not applicable on this plan
Network(s): Regence Traditional/ValueCare

Find a Doctor
Yes Prescription benefits
No Dental
No Vision
Yes No Referrals
Yes Maternity
Yes Preventive Care
Yes Alternative Care
Yes Mental Health
 

Basic Features

Cost Sharing
Deductibles:
  • $7,500 per member
  • $15,000 per family
Annual OOP Max:
  • $10,000 per member per calendar year
  • $18,000 per family per calendar year
  • Amounts include the deductible
Coinsurance Max:

Not applicable on this plan
Lifetime Max: $2 million paid by Regence per member
Copay:

Not applicable on this plan
Coinsurance:
  • You pay 30% when using contracted providers
  • You pay 45% when using non-contracted providers
Everyday Needs
Prescriptions:

You pay 30% coinsurance after the deductible
Preventive Care:
  • Deductible and coinsurance
  • Adults and children age 6 and over are limited to $300 per member per calendar year
  • Children between 2-5 are limited to four visits per year
  • Children 2 and under are limited to ten visits in first 24 months
Vision:

Not covered
Office Visits:
  • After the deductible, you pay 30% coinsurance using contracted providers
  • After the deductible, you pay 45% coinsurance using non-contracted providers
Diagnostic x-ray services:

Deductible and coinsurance
Outpatient Laboratory services:

Deductible and coinsurance
Special Needs
Alternative care:
  • Only chiropractic is covered
  • Deductible and coinsurance
Maternity:
  • Separate $5,000 copayment
  • No coinsurance
  • No deductible applies
Mental Health:
  • Deductible and 50% coinsurance
  • Limited to $1,500 per calendar year
  • Limit does not apply to out-of-pocket maximum
Other considerations
Network(s):

Contracted Providers

  • Regence Traditional
  • ValueCare

Non-Contracted Providers

  • Providers outside of the networks above

Benefit Summary

Rates

Rates for all Individual and Family plans will change effective July 1, 2009.

About rate changes: We typically adjust rates once a year in July, but the state legislature may mandate changes that affect the cost at other times of the year. Your rate may be adjusted at those times, even if you enrolled for coverage in the previous month.

Medical Exclusions and Limitations

DOC (1k) Exclusions and Limitations: BlueBasic Coinsurance - $7,500 Deductible

Alternative Care Excluded
Birth Control Included (except for non-prescription contraceptives)
Cosmetic OR Reconstructive Surgery Excluded
Counseling Excluded
Custodial Convalescent Cures Excluded
Dental Services Excluded (accidental injury to sound natural teeth is covered)
Durable Medical Equipment Not limited
Erectile Dysfunction Excluded
Foot Care Excluded
Gastric Procedures such as gastric bypass Excluded
Genetic Services Excluded
Growth Hormone Benefit Excluded
Hearing Treatment Excluded
Home Health Care Not limited
Infertility Excluded
Maternity Care Included after $5,000 copayment
Mental Health Treatment $1,500 limit per enrollee per calendar year
Obesity or Weight Control Excluded
Orthognatic Surgery Excluded
Pre-existing conditions 12 month waiting period
Rehabilitative Care (inpatient) Not limited
Rehabilitative Care (outpatient) $1,500 limit per enrollee per calendar year (includes chiropractic care)
Sterilization 12 month waiting period
Temporomandibular Joint Disorder Excluded
Transplants Not limited
Tobacco Addiction Treatment Excluded
Vision Excluded
You must be continuously covered for at least 12 months before we pay for any of the following
Pre-existing conditions 12 month waiting period
Sterilization 12 month waiting period
Preventative Care
Children — first 24 months 10 exams included
Children — age 2—5 Four exams per enrollee per calendar year
Children — ages 6 and older Limited to $300 per enrollee per calendar year
Adult men and women Limited to $300 per enrollee per calendar year

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