Blue Cross and Blue Shield of Arizona Blue Essential Plan Plan Information
Deductibles
Individual: $250, $500, $1,000, $2,000, $3,000, $5,000, $7,500, $10,000
Family: $750, $1,500, $3,000, $6,000, $9,000, $15,000, $22,500, $30,000
Coinsurance
60% (You pay 40%)
Out-of-Pocket Coinsurance Maximum
$4,000 per member
Physician Services
PCP Office Visit: $25 Copay
Specialist Office Visit: 60%
Urgent Care
Urgent Care Facility: $60 Copay per member
Preventive Services
Certain Screening Services, Immunizations, Routine Physicals: 60%
Laboratory Services
100%
Prescriptions
Generic: $15 Copay
Brand Name: $125 Copay
Inpatient Hospital Services
60% after deductible
Outpatient Hospital Services
60% after deductible
Emergency
$150 access fee per member, then 60% after deductible. Access fee waived if admitted.
Ambulance: 60%
Maternity-Complications Only
60% after deductible
Physical, Occupational and Speech Therapy
60% after deductible
Chiropractic
60% after deductible.
Vision
$25 Copay for one routine eye exam per member per year
Mental Health
Outpatient: $15 Copay per visit (20 sessions per member, per year)
Inpatient: 60% after deductible (2 admissions per person, per year and a total of 30 days)
Other Blue Cross and Blue Shield of Arizona health insurance plans:
