The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Taking Action to Address Racial Health Disparities Learn how Blue Cross and Blue Shield companies are addressing our nation's. $0 copay: $175 inpatient. $0 pre-/postnatal professional care; $1,500 for facility care: Urgent Care Center $30 copay. ER (accidental injury) $0 within 72 hours. $125 per day per facility. $0 within 72 hours. ER (medical emergency) 15%.
Blue Cross Blue Shield Federal Copay 2020
| Basic Option | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care | $30 for primary care1 |
| Virtual doctor visits by Teladoc® | $0 for first 2 visits |
| Urgent Care Center | $35 copay |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $10 copay Tier 2 (Preferred brand): $55 copay2 Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2 Tier 4 (Preferred specialty): $65 copay2 Tier 5 (Non-preferred specialty): $90 copay2 Mail Service Pharmacy: Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $20 Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy: Tier 4 (Preferred specialty): $85 copay2 Tier 5 (Non-preferred specialty): $110 copay2 |
| Maternity Care | $175 inpatient $0 outpatient |
| Hospital Care | Inpatient (Precertification is required): $175 per day; up to $875 per admission Outpatient: $100 per day per facility1 |
| Surgery | $150 in an office setting1 $200 in a non-office setting1 |
| ER (accidental injury) | $175 per day per facility |
| ER (medical emergency) | $175 per day per facility |
| Lab work (such as blood tests) | $0 copay1 |
| Diagnostic services (such as sleep studies, CT scans) | Up to $100 in an office1 Up to $150 in a hospital1 |
| Chiropractic Care | $30 per treatment; up to 20 visits per year |
| Dental Care | $30 copay per evaluation; up to 2 per year |
| Rewards Program | Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |