Blue Cross and Blue Shield of Arizona Blue Secure Plan Plan Information
Deductible
$1,000 per member
Coinsurance
100% after deductible
Out-of-Pocket Coinsurance Maximum
$3,500 per member
Physician Services
PCP: $30 Copay
Specialist: $40 Copay
Urgent Care
In State Facility: $50 Copay
Laboratory Services
100% after deductible
Prescriptions
Level 1: $15
Level 2: $40
Level 3: $70
Level 4: $120
Inpatient Hospital Services
80% after deductible
Outpatient Hospital Services
$300 Copay for outpatient surgery
Emergency
$300 Copay (Copay waived if admitted)
Ambulance: 100%
Maternity-Complications Only
100% after deductible
Physical, Occupational and Speech Therapy
100%
Chiropractic
$40 Copay
Vision Exams
$40 Copay
Mental Health
Outpatient: $15 Copay per member(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:
