Blue Advantage Gold PPO 309

Plan Type: PPO
Plan Tier: Gold
Medical Deductible - Individual: $1,200
Medical Deductible - Family: $3,600
Drug Deductible - Individual: Included in Medical
Drug Deductible - Family: Included in Medical
Out of Pocket Max - Individual: $7,900
Out of Pocket Max - Family: $15,800
Primary Care Visit: $25
Specialist Visit: 25% Coinsurance after deductible
Emergency Room: $950 Copay with deductible and 25% Coinsurance after deductible
Hospital - Physician: 25% Coinsurance after deductible
Hospital - Facility: $400 Copay per Stay with deductible and 25% Coinsurance after deductible
Link to Full SBC: http://www.bcbsok.com/sbc/2019/GPSH45BVPIOKP.pdf
Plan Brochure: http://www.bcbsok.com/brochure/2019/ok-plan-overview.pdf

Other Coverage:

Child Dental: No
Adult Dental No

Prescription Drug Pricing:

Generic Drugs: $5
Non-Preferred Brand Drugs: $100
Preferred Brand Drugs: $50
Specialty Drugs: 45% Coinsurance after deductible
Link to Full Policy Formulary: https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2019/2019_OK_6T_HIM.pdf

About The Carrier

One of the larger provider networks in Oklahoma. A wide range of choices in plans, coverage and price levels. Innovative cost-of-care products and programs that improve health and reduce expenses. Let Anthem help you customize medical benefits that work best for your employees and your budget.

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