BlueCross BlueShield of Alabama
Questions? Call 1-855-828-3982 (TTY 711)* Open Now

2021 Plan Benefits

Blue Advantage
Complete (PPO)

$0 per month

Enroll Now

Blue Advantage
Premier (PPO)

$170 per month

Enroll Now
Primary Care Doctor Visit Copay$5 per visit$5 per visit
Specialist Visit Copay$40 per visit$25 per visit
Inpatient Hospital Copay$225 per day for days 1–7;
$0 for days 8-365
$175 per day for days 1–5;
$0 for days 6-365
Outpatient Hospital Copay$250$150
Physical, Occupational and Speech Therapy Session$30 per visit$20 per visit
Lab Services$0 copay$0 copay
X-rays$15 copay$5 copay
Diagnostic Radiology (MRI, CT scans)$75$25
Post Discharge Meals (for members with two of the following chronic conditions: COPD, diabetes, CHF, vascular disease, rheumatoid arthritis)$0
14 meals delivered
$0
14 meals delivered
Emergency Room Visit$90 copay
Waived if admitted
$120 copay
Waived if admitted
Skilled Nursing Facility (prior hospital stay not required)$0 per day for days 1–20;
$160 for days 21-80;
$0 for days 81-100
$0 per day for days 1–20;
$100 for days 21-55;
$0 for days 56-100
Ambulance$275 copay$150 copay
Diabetic Supplies (Glucometer, test strips***)$0 copay$0 copay
Many Preventive Wellness Services$0 copay$0 copay
Durable Medical Equipment20% of cost20% of cost
Routine Eye Exam$0 copay$0 copay
Eyewear Allowance$100 per calendar year$100 per calendar year
Comprehensive and Preventive Dental Allowance$500 per calendar year$750 per calendar year
Annual Routine Vision and Hearing Exam$0
Must use a TruHearing® network provider for hearing exam
$0
Must use a TruHearing® network provider for hearing exam
Hearing Aids*$699/$999 copay
One high-tech TruHearing branded hearing aid per ear, per-year
$699/$999 copay
One high-tech TruHearing branded hearing aid per ear, per-year
Maximum Out-of-Pocket Amount$5,100 (in-network)
$7,500 (combined in/out-of-network)
$3,400 (in-network)
$5,100 (combined in/out-of-network)
Blue Advantage Includes Prescription Drug Coverage
Part D Deductible
Tiers 1, 2 and 6$0$0
Tiers 3, 4 and 5$150 annual$0
Part D Drug Copays/Coinsurance at Preferred Pharmacies
Tier 1
 – 
Preferred Generic
$4$3
Tier 2
 – 
Generic
$13$8
Tier 3
 – 
Preferred Brand
$40$40
Tier 4
 – 
Non-Preferred Drug
45%45%
Tier 5
 – 
Specialty Tier
25%33%
Tier 6
 – 
Select Care Drugs
$0$0
Part D Coverage GapYou pay 25% of generic drug costs and 25% of brand-name drug costs.You pay 25% of generic drug costs and 25% of brand-name drug costs.
Part D Catastrophic CoverageYou pay the greater of $3.70 for generic drugs and $9.20 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest.You pay the greater of $3.70 for generic drugs and $9.20 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest.

Blue Advantage
Complete (PPO)

$0 per month

Enroll Now

Blue Advantage
Premier (PPO)

$170 per month

Enroll Now

** SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © Tivity Health, Inc. All rights reserved.

* TruHearing is an independent company offering exclusive hearing aid savings for Blue Cross and Blue Shield of Alabama members. For Routine Hearing Exams and Hearing Aids services, you must see a TruHearing provider to use these benefits. Please call 1-855-541-6179 to locate a TruHearing provider and to schedule an appointment.

*** Glucometer and test strip brands include Ascensia (CONTOUR™NEXT & PLUS) and LifeScan (OneTouch®).

This information is not a complete description of benefits. Call 1-855-828-3982 (TTY 711)* for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider networ may change at any time. You will receive notice when necessary. To the extent of any discrepancy between this web site and your Evidence of Coverage/Contract Booklet, your Evidence of Coverage/Contract Booklet takes priority.