Blue Cross of Idaho

PQA Southeast Bronze Connect 8550

Plan Overview

Medical Deductible
  • Individual: $8,550
  • Family: $17,100
  • Per Person: $8,550
Prescription Drug Deductible
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical
Medical Out-of-Pocket Maximum
  • Individual: $8,550
  • Family: $17,100
  • Per Person: $8,550
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $40 Copay
Specialist
  • Standard: $130 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: No Charge after deductible
Non Preferred Brand Drugs
  • Standard: No Charge after deductible
Generic Drugs
  • Standard: $25 Copay
Specialty Drugs
  • Standard: No Charge after deductible

Inpatient Coverage

Hospital Services
  • Standard: No Charge after deductible
Inpatient Services
  • Standard: No Charge after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: No Charge after deductible
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