(844) 967-1917
BlueCross BlueShield of South Carolina

BlueEssentials Gold 2

Plan Overview

Medical Deductable
  • Individual: $2,500
  • Family: $5,000
  • Per Person: $2,500
Prescription Drug Deductible
  • Individual: $0
  • Family: $0
  • Per Person: $0
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $6,000
  • Family: $12,000
  • Per Person: $6,000

Office Visit

Primary Doctor
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: You can save time and reduce your copay by consulting a physician using the telehealth service, Blue CareOnDemand. See our brochure or visit www.BlueCareOnDemandSC.com for more details.
Specialist
  • CoPay: $50.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: $50.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Non Preferred Brand Drugs
  • CoPay: $100.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Generic Drugs
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Specialty Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered

Inpatient Coverage

Hospital Services
  • CoPay: No Charge after deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered
Inpatient Services
  • CoPay: No Charge after deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: $300.00 Copay with deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: An out-of-Network Provider may Balance-Bill you for the difference between the Allowed Amount we pay and their billed charge.
Urgent Care Facility
  • CoPay: $50.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Services rendered at Doctors Care facilities are provided at in-network Primary Care benefits. An out-of-Network Provider may Balance-Bill you for the difference between the Allowed Amount we pay and their billed charge.

Maternity

Labor and Delivery Hospital Stay
  • CoPay: No Charge after deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: No Preauthorization is required for the mother's hospitalization related to the delivery of a newborn child when the mother's hospital stay is 48 hours or less for a vaginal birth or 96 hours or less for a cesarean section. Confinements exceeding these limits require Preauthorization.
Pre and Postnatal Office Visit
  • CoPay: No Charge after deductible
  • CoInsurance: 30.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Prenatal and postnatal care will be covered after artificial insemination or in-vitro fertilization, but the actual insemination/fertilization is not covered.

Vision

Routine Eye Exams For Children
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children
  • Covered: Not Covered
Basic Dental Care - Child
  • Covered: Not Covered
Major Dental Care - Child
  • Covered: Not Covered
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
HealthMarkets is an authorized agent of BlueCross BlueShield of South Carolina.
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