Capital BlueCross

Gold Capital Advantage EPO 2150/10/20

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: 2150 Family: 4300 Per Person: 2150
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: 8550 Family: 17100 Per Person: 8550
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $20 Copay
Specialist	Standard: $45 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $25 Copay after deductible
Non Preferred Brand Drugs	Standard: $75 Copay after deductible
Generic Drugs	Standard: $10 Copay
Specialty Drugs	Standard: 40% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 10% Coinsurance after deductible
Inpatient Services	Standard: 10% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: $300 Copay after deductible

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

Can you go to the dentist while pregnant?

Having healthy teeth and gums can help you have a healthy pregnancy. In fact,…Read More

Read More

What is a drug formulary, and what does it cover?

There are a lot of things to consider when choosing a health plan. If…Read More

Read More

What you need to know about accelerated life insurance benefits

Life insurance might seem straightforward: You buy a policy, pay for it annually or…Read More

Read More