Blue Choice Platinum for Business - 46944AL0280001 Health Insurance Plan
Blue Cross and Blue Shield of Alabama health insurance plan with the Plan ID 46944AL0280001. The plan is called Blue Choice Platinum for Business.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 90.81% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 9.19% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 46944AL0280001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Alabama | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Alabama | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 46944AL0280001-01 | ||||||||||||||||||
| Provider Network(s) | TIER-ONE | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 18 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of Blue Choice Platinum for Business Health Insurance Plan, 46944AL0280001-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Bariatric Surgery
Limit: 1.0 Procedure(s) per Lifetime Limited to Bariatric Surgery Network |
YES | 20.00% |
100.00% |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
Benefits are available up to the end of the month in which the member turns 19. |
YES | 20.00% |
100.00% |
| Chemotherapy
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Chiropractic Care
Limit: 15.0 Visit(s) per Year |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
|
YES | $150.00 |
$300.00, 20.00% |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year Benefits are available up to the end of the month in which the member turns 19. |
YES | No Charge |
100.00% |
| Diabetes Education
Limit: 10.0 Hours per Year Limited to 2 hours per year after initial 12-month educational period. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Dialysis
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Durable Medical Equipment
|
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Emergency Room Services
|
YES | $150.00 |
$150.00 |
| Emergency Transportation/Ambulance
|
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Benefits are available up to the end of the month in which the member turns 19. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Gender Affirming Care
Exclusions: Excludes services deemed as cosmetic. |
YES | $150.00 |
$300.00, 20.00% |
| Generic Drugs
Up to a 90-day supply |
YES | $10.00 |
100.00% |
| Habilitation Services
Limit: 30.0 Visit(s) per Year Combined maximum visits for Occupational, Physical and Speech therapy |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Hearing Aids
|
NO | ||
| Home Health Care Services
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Hospice Services
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs)
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Infertility Treatment
Exclusions: Excludes Assisted Reproductive Technology |
YES | $30.00 |
20.00% Coinsurance after deductible |
| Infusion Therapy
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | $150.00 Copay per Day |
$300.00 Copay per Stay, 20.00% |
| Inpatient Physician and Surgical Services
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
Benefits are available up to the end of the month in which the member turns 19. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Inpatient Services
|
YES | No Charge |
20.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | $30.00 |
50.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs
Up to a 90-day supply |
YES | $75.00 |
100.00% |
| Nutritional Counseling
Limit: 6.0 Hours per Year |
YES | $20.00 |
20.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Benefits are available up to the end of the month in which the member turns 19. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $20.00 |
20.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | $150.00 |
20.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services
Limit: 30.0 Visit(s) per Year Combined maximum visits for Occupational, Physical and Speech therapy |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Preferred Brand Drugs
Up to a 90-day supply; Covered insulins limited to a $99 member cost share per 30-day supply |
YES | $35.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Preventive Care/Screening/Immunization
|
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
|
YES | $20.00 |
20.00% Coinsurance after deductible |
| Private-Duty Nursing
|
NO | ||
| Prosthetic Devices
|
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Radiation
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Reconstructive Surgery
|
YES | No Charge |
20.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 30.0 Visit(s) per Year Combined maximum visits for Occupational, Physical and Speech therapy |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy
Limit: 30.0 Visit(s) per Year Combined maximum visits for Occupational, Physical and Speech therapy |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
Limit: 75.0 Dollars per Year Includes eye exam and refraction for members age 19 and over. |
YES | No Charge |
100.00% |
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Benefits are available up to the end of the month in which the member turns 19. |
YES | 20.00% Coinsurance after deductible |
100.00% |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
|
NO | ||
| Specialist Visit
|
YES | $30.00 |
20.00% Coinsurance after deductible |
| Specialty Drugs
Up to a 30-day supply |
YES | $100.00 |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | No Charge |
20.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | $30.00 |
50.00% Coinsurance after deductible |
| Transplant
Limited to Blue Distinction Centers for Transplant Network |
YES | No Charge |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: Dental-related services Limited to Phase I services |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities
|
YES | $20.00 |
20.00% Coinsurance after deductible |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | No Charge |
20.00% Coinsurance after deductible |
Blue Choice Platinum for Business Health Insurance Plan Variant 46944AL0280001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Standard Platinum On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy |
| First Tier Utilization | 100% |
| Formulary ID | ALF002 |
| Formulary URL | URL |
| HIOS Product ID | 46944AL028 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2024-09-18 01:01:22 |
| Inpatient Copayment Maximum Days | 5 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 90.81% |
| Issuer ID | 46944 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Alabama |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Platinum |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | ALN004 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 46944AL0280001-01 |
| Plan Marketing Name | Blue Choice Platinum for Business |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Choice Platinum for Business |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $300 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $10 |
| SBC Scenario, Having Diabetes, Copayment | $500 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $40 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ALS003 |
| Source Name | HIOS |
| Plan ID | 46944AL0280001 |
| State Code | AL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $100 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $100 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $200 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $100 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $8000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $4000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $4,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Blue Choice Platinum for Business Health Insurance Plan, 46944AL0280001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Blue Choice Platinum for Business, 46944AL0280001 Health Insurance Plan, 46944AL0280001
-
Does Blue Choice Platinum for Business Health Insurance Plan, 46944AL0280001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (46944AL0280001) Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs?
Does (46944AL0280001) Health Insurance Plan, Variant (46944AL0280001-01) have Out Of Country Coverage?
Does (46944AL0280001) Health Insurance Plan, Variant (46944AL0280001-01) have Out of Service Area Coverage?
Does (46944AL0280001) Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs?
Does Blue Choice Platinum for Business Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs for Asthma?
Does Blue Choice Platinum for Business Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs for Heart disease?
Does Blue Choice Platinum for Business Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs for Diabetes?
Does Blue Choice Platinum for Business Health Insurance Plan, Variant (46944AL0280001-01) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API