Even better, the plan comes with the valuable extra benefits such as dental, vision, hearing and fitness coverage that helps save you even more. And with the Silver & Fit® Program, you can get a no-cost fitness facility membership with access to a broad network of participating fitness facilities nationwide or the Home Fitness option, plus rewards, challenges and much more.
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Covered Benefit
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Member Share
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Plan Year Deductible
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$0
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Out-of-Pocket-Maximum (In-Network)
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$2,000
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Out-of-Pocket Maximum (Out-of-Network)
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N/A
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Co-pay – Primary Care/Specialist
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$5/$20 per visit (In network)
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Emergency Room
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$50 co-pay per visit
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Inpatient Hospital
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$50/day (days 1-10 in network)
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Prescription Drugs (Part D)
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 Tier 1- Tier 2
- Tier 3
- Tier 4
- Tier 5
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| You may view the formulary at www.bcbsla.com/blueadvantage |
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Additional Benefits
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Preventative Dental
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$0 copay for preventative visits.
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Eye-wear
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$130 allowance for one pair of frames or contact lenses per year
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Over-the-Counter (OTC) Allowance
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50 credits per quarter OTC benefits (includes over-the-counter drugs, incontinence supplies and other medical and first aid supplies)
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Online Primary Care Provider Visits
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$0 copay for online primary care provider visits (available on a computer, tablet and smartphone 24 hours a day, 7 days a week)
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Post Discharge Meals
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2 meals per day, up to 5 days (after discharge from acute-care inpatient stay)
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Member Wellness Rewards
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Up to $50 per year in gift cards for completing approved wellness exams and/or screenings
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