BlueSaver (2018)

BlueSaver is a qualified high-deductible plan. You can put tax-free money in a Health Savings Account (HSA)* that will help you pay your deductible and your share of covered medical expenses.

Preferred Care PPO

NETWORK

=

Blue Saver

PLAN

  • GOLD
  • SILVER
  • BRONZE

Here are some plan features and benefits:


No copayments.


Two-tier coinsurance structure for prescription drugs. Once your medical deductible is met, the amount of your coinsurance depends on the plan you buy.


No separate drug deductible; medical deductible applies.


We pay 100 percent of preventive care services in network .


For pediatric dental and vision, $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor.

Plan Name

Blue Saver 90/70
$5,000

S Silver

Blue Saver 90/70
$3,300

S Silver

Blue Saver 60/40
$4,500

B Bronze
Here are the basics:
Deductible (single) $3,000 $3,300 $4,500
Deductible (family) $6,000 $6,600 $9,000
Most you pay out of pocket (single) $6,550 $6,550 $6,550
Most you pay out of pocket (family) $13,100 $13,100 $13,100
Coinsurance we pay in network 90% 90% 60%
Coinsurance you pay in network 10% 10% 40%
Coinsurance we pay out of network 70% 70% 40%
Coinsurance you pay out of network 30% 30% 60%
What you'll pay if you go to the following places:
Doctor's office (includes Primary Care, QBPC or Specialists Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
Urgent Care Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
Outpatient ambulatory surgical center Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
Emergency room Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
Admitted as inpatient to hospital Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies No separate drug deductible; medical deductible applies No separate drug deductible; medical deductible applies
Prescription drugs per fill

Tier 1: Generic 10% after deductible

Tier 2: Preferred Brand 10% after deductible

Tier 1: Generic 10% after deductible

Tier 2: Preferred Brand 10% after deductible

Tier 1: Generic 40% after deductible

Tier 2: Brand 60% after deductible

Preventive care services Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network
Pregnancy care office visit Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 10% coinsurance Deductible then 10% coinsurance Deductible then 40% coinsurance

Mental health and substance abuse (office)

Mental heath and substance abuse (inpatient)

Mental health (outpatient)

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 40% coinsurance

Deductible then 40% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic & preventive dental and routine eye exams & hardware when received from a network provider

Plan Name

90/70
$5,000

S Silver
Here are the basics
Deductible (single) $3,000
Deductible (family) $6,000
Most you pay out of pocket (single) $6,550
Most you pay out of pocket (family) $13,100
Coinsurance we pay in network 90%
Coinsurance you pay in network 10%
Coinsurance we pay out of network 70%
Coinsurance you pay out of network 30%
What you'll pay if you go to the following places:
Doctor's office (includes Primary Care, QBPC or Specialists Deductible then 10% coinsurance
Urgent Care Deductible then 10% coinsurance
Outpatients ambulatory surgical center Deductible then 10% coinsurance
Emergency room Deductible then 10% coinsurance
Admitted as inpatient to hospital Deductible then 10% coinsurance
What you'll pay for prescription drugs and other medical services
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill

Tier 1: Generic 10% after deductible

Tier 2: Preferred Brand 10% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 10% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 10% coinsurance
Mental health and substance abuse (inpatient & outpatient)

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic & preventive dental and routine eye exams & hardware when received from a network provider

Plan Name

90/70
$3,300

S Silver
Here are the basics
Deductible (single) $3,300
Deductible (family) $6,600
Most you pay out of pocket (single) $6,550
Most you pay out of pocket (family) $13,100
Coinsurance we pay in network 90%
Coinsurance you pay in network 10%
Coinsurance we pay out of network 70%
Coinsurance you pay out of network 30%
What you'll pay if you go to the following places:
Doctor's office (includes Primary Care, QBPC or Specialists) Deductible then 10% coinsurance
Urgent Care Deductible then 10% coinsurance
Outpatients ambulatory surgical center Deductible then 10% coinsurance
Emergency room Deductible then 10% coinsurance
Admitted as inpatient to hospital Deductible then 10% coinsurance
What you'll pay for prescription drugs and other medical services
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill

Tier 1: Generic 10% after deductible

Tier 2: Preferred Brand 10% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 10% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 10% coinsurance
Mental health and substance abuse (inpatient & outpatient)

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Deductible then 10% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic & preventive dental and routine eye exams & hardware when received from a network provider

Plan Name

60/40
$4,500

B Bronze
Here are the basics
Deductible (single) $4,500
Deductible (family) $9,000
Most you pay out of pocket (single) $6,550
Most you pay out of pocket (family) $13,100
Coinsurance we pay in network 60%
Coinsurance you pay in network 40%
Coinsurance we pay out of network 40%
Coinsurance you pay out of network 60%
What you'll pay if you go to the following places:
Doctor's office (includes Primary Care, QBPC or Specialists) Deductible then 40% coinsurance
Urgent Care Deductible then 40% coinsurance
Outpatients ambulatory surgical center Deductible then 40% coinsurance
Emergency room Deductible then 40% coinsurance
Admitted as inpatient to hospital Deductible then 40% coinsurance
What you'll pay for prescription drugs and other medical services
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill

Tier 1: Generic 40% after deductible

Tier 2: Brand 60% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 40% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 40% coinsurance
Mental health and substance abuse (inpatient & outpatient)

Deductible then 10% coinsurance

Deductible then 40% coinsurance

Deductible then 40% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic & preventive dental and routine eye exams & hardware when received from a network provider
*HealthEquity, Inc. is an independent company that administers Health Savings Accounts to Blue Cross members enrolled in BlueSaver, our high-deductible health plans. Members who qualify may open a HSA with any HSA administrator and should seek guidance from a tax professional or financial advisor. Blue Cross and Blue Shield of Louisiana is not engaged in rendering tax, legal or investment advice.