When it comes to health insurance, it's always important to find quality and reliable protection. Essential Blue is designed to provide you the essential health care coverage you need with affordable premiums. The program is ideal for basic, routine preventive care coverage such as doctor check-ups, generic prescription drugs and hospital stays while still offering coverage for many other services. Essential Blue pays a maximum of $30,000 in benefits for all covered health services (subject to deductibles and coinsurance) per covered person, each benefit period.
Learn how the Blue Choice network enhances your Essential Blue coverage
Benefit Summary
Office Visit Services*
$25 copay per visit (except for initial visit for an accidental injury) up
to a maximum of five visits for each covered person (15 visits for three-or-more
persons) each benefit period. Covered services include:
Initial Outpatient Coverage for Accidental Injuries*
$50 copay for the initial outpatient visit, when received within 60 days of
the date of injury. (This initial visit does not apply to the 5/15 office
visit maximums shown above.) If admitted within 24 hours of the initial visit,
the copay is waived and benefits are subject to the “Other Services” deductible
and coinsurance amounts shown below.
Outpatient Radiology & Lab Services (including accidental
injury services)*
Pays a maximum of $300 of combined services for each covered person ($900 for
three-or-more persons) each benefit period.
Hospice Rider
Pays 100% Home Health Care up to $2,500 per person each
benefit period. Pays Hospice 100% with a $5,000 lifetime maximum.
BlueRx Direct Outpatient Prescription Drugs (generic drugs only)
$100 deductible for each covered person ($300 maximum for three-or-more persons).
Then benefits are paid at 50% of allowable charges for the remainder of the
benefit period. Drug costs will not count toward the benefit period maximum.
Other Covered Services
*Your deductible is $1,000 for each
covered person ($3,000 maximum for three-or-more persons). After
the deductible, you pay 20% of allowable charges to a maximum out-of-pocket
expense of $1,000 for each covered person ($3,000 for three-or-more
persons).
Covered services include in-hospital care, ambulance services, surgery and anesthesia, outpatient surgery, nervous and mental services (limited), maternity and newborn services and amounts in excess of the maximums for office visit and outpatient medical services as shown above.
Optional Benefits:
Exclusions
See the Exclusions page
for details.
Additional Program Information
More Information
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the features of Essential Blue.