Blue Cross and Blue Shield of Arizona Blue Optimum Plan Plan Information
Deductibles
Individual: $250, $500, $1,000, $2,000, $3,000, $5,000, $7,500, $10,000
Family: $500, $1,000, $2,000, $4,000, $6,000, $10,000, $15,000, $20,000
Coinsurance
80% (You pay 20%)
Out-of-Pocket Coinsurance Maximum
$2,500 per member
Physician Services
PCP Office Visit: $25 Copay
Specialist Office Visit: $50 Copay
Urgent Care
Urgent Care Facility: $60 Copay per member
Preventive Services
Certain Screening Services, Immunizations, Routine Physicals: $25 or $50 Copay per member depending on whether services are received from a PCP or specialist.
Mammography: 80%
Laboratory Services
100%
Prescriptions
Perscription Deductible: $250
Level 1: $15 Copay
Level 2: $35 Copay
Level 3: $65 Copay
Level 4: $120 Copay
Inpatient Hospital Services
80%
Outpatient Hospital Services
80%
Emergency
$150 access fee per member, then 80% after deductible. Access fee waived if admitted.
Ambulance: 80%
Maternity-Complications Only
80%
Physical, Occupational and Speech Therapy
80%
Chiropractic
$50 Copay per member, then 80% 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: 80% 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:
