BlueSelect Platinum 1457
| Plan Type: | EPO |
| Plan Tier: | Platinum |
| Medical Deductible - Individual: | No |
| Medical Deductible - Family: | Included in Medical |
| Drug Deductible - Individual: | No |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $2000 |
| Out of Pocket Max - Family: | $2000 |
| Primary Care Visit: | $10 |
| Specialist Visit: | $20 |
| Emergency Room: | $75 |
| Hospital - Physician: | No Charge |
| Hospital - Facility: | $350 Copay per Day |
| Link to Full SBC: | http://www.bcbsfl.com/DocumentLibrary/SBC/2020/1457.pdf |
| Plan Brochure: | https://www.flblue.com/plan-brochure/bs?id=1457 |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $10 |
| Non-Preferred Brand Drugs: | $0.30 |
| Preferred Brand Drugs: | $40 |
| Specialty Drugs: | $0.50 |
| Link to Full Policy Formulary: | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2020/2020_FL_7T_CareChoices.pdf |
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