Web Content Viewer - Metadata
Page Properties DnD
Breadcrumb DnD
Plain Page Title DnD
BlueJourney PPO
Select a BlueJourney PPO plan that meets your needs.
Plain Page with Image DnD
Office visits to your family doctor are covered at a low co-payment. We reimburse you for all medically necessary benefits. It may cost more to get care from out-of-network provides with the exception of emergency and urgent care.
| Service Area | BlueJourney Prime PPO |
BlueJourney Classic PPO |
||
|---|---|---|---|---|
| In Network |
Out of Network |
In Network |
Out of Network |
|
| Enroll Online | Enroll Online | |||
| Monthly Premium |
$170 |
$49 |
||
| Deductible |
$0 |
$250 |
$0 |
$350 |
| Primary Care Physician Office Visits |
$5 copay |
$5 copay |
$5 copay |
$5 copay |
| Specialty Office Visit |
$25 copay |
$25 copay |
$30 copay |
$30 copay |
| Urgent Care |
$35 copay |
$35 copay |
$45 copay |
$45 copay |
| Inpatient Hospital Stay |
$100 per day for days 1-6 |
$100 per day for days 1-6 |
$225 per day for days 1-6 |
$225 per day for days 1-6 |
| Ambulatory Surgical Center (ASC) |
$125 copay |
$125 copay |
$225 copay |
$225 copay |
| Outpatient Surgery |
$225 copay |
$225 copay |
$300 copay |
$300 copay |
| Emergency Care (copayment waived if admitted) |
$90 copay |
$90 copay |
$90 copay |
$90 copay |
| Labs |
$10 copay |
$10 copay |
$10 copay |
$10 copay |
| X-rays |
Outpatient x-ray $20 copay |
Outpatient x-ray $20 copay |
Outpatient x-ray $25 copay |
Outpatient x-ray $25 copay |
| Diagnostic Radiology (not including x-rays) |
$125 copay |
$125 copay |
$200 copay |
$200 copay |
| Diabetes Self-Monitoring Training and Supplies |
No copay |
20% per item |
No copay |
20% per item |
| Hearing Services |
$0 copay for routine hearing exam, Limit 1 exam per calendar year ($800 allowance every 3 years for hearing aids) |
50 % | $0 copay for routine hearing exams, Limit 1 exam per calendar year ($800 allowance every 3 years for hearing aids) |
50% |
| Routine Vision Services |
$20 copay One eye exam every calendar year $125 allowance toward eyeglass frames or contact lenses every 2 years |
50% |
$20 copay One eye exam every calendar year $125 allowance toward eyeglass frames or contact lenses every 2 years |
50% |
| Expanded Dental Services |
$10 copay (includes 2 cleanings, bitewing x-rays (set of two), oral exam) |
50% |
$10 copay (includes 2 cleanings, bitewing x-rays (set of two), oral exam) |
50% |
| SilverSneakers® Fitness Benefit |
$0 copay | 50% |
$0 copay |
50% |
| Durable Medical Equipment |
20% |
20% |
20% |
20% |
| Prescription Drug Benefits |
$0 deductible | |||
| Over-the-counter |
$25 monthly allowance for over-the-counter (OTC) drugs and supplies. Unused allowance may not be carried over from one month to the next. |
$25 monthly allowance for over-the-counter (OTC) drugs and supplies. Unused allowance may not be carried over from one month to the next. |
||
| Transportation Benefit |
24 plan approved round trips |
24 plan approved round trips |
||
| Meals Benefit – Post Hospital Discharge | 2 meals per day for 7 days |
2 meals per day for 7 days |
||
| In-home Support Services: Grandkids on Demand |
5 hours per month included |
5 hours per month included |
||
| Landmark Health |
$0 copay | $0 copay |
||
| Medical Nutritional Therapy |
$0 copay |
$0 copay |
||
| Nutritional/Dietary Benefit |
$0 copay |
$0 copay |
||
| Virtual Care |
$0 copay |
$0 copay | ||
| Health Coaching and Education Benefit |
$0 copay | $0 copay | ||
Web Content Viewer - Fixed Context
Updated October 1, 2020
Y0016_WBST21_M