Anthem Blue Cross and Blue Shield of Connecticut BlueCare Direct Plan Information
Plan Name:BlueCare Direct
Provider/ Facilities:HMO
Lifetime Maximum Benefit:$5 Million per member
Out-of-Network Benefits:No - except for emergency and urgent care
In-Network Benefits:In-Network You Pay
Doctor Visits:You pay $20 for PCP and $30 for specialist.
No deductible.
Prescription Drug:Prescription card: You pay $10 copayment on Generic Drugs, $25 copayment on Formulary Brand-Name Drugs and $40 copayment on Non-Formulary Brand-Name Drugs.
No deductible.
$500 or $2,000 annual maximum depending on option chosen.
Outpatient Surgery (In a hospital or surgi-center):You pay subject to the deductible.
Outpatient Services:You pay $20 copayment per visit.
No deductible.
Preventive Care:You pay $20 per visit based on age schedule.
No deductible.
Preventive care and immunizations for children:You pay $20 copayment per visit. Up to Age 13, No Cost Share.
No deducible.
Hospital Inpatient Services:No charge after deductible.
Emergency Care:Emergency Room: You pay $75 copayment (waived if admitted).
Ambulance:
Maximum for land: Paid according to the Department of Public Health Ambulance Service Rate Schedule.
Maximum for air: $4,000 per trip.
Other Anthem Blue Cross and Blue Shield of Connecticut health insurance plans:
