2020 Plan Overview
Comprehensive
Coverage
Prescription
Drugs
Vision
Exams
Hearing
Exams
Blue Advantage (PPO)
Blue Advantage conveniently provides both medical and prescription drug benefits, making it a smart choice for people who want affordable, comprehensive coverage in one simple, effective plan.
2020 Plan Benefits
 | Blue Advantage | Blue Advantage | |
|---|---|---|---|
| Primary Care Doctor Visit Copay | $10 per visit | $5 per visit | |
| Specialist Visit Copay | $40 per visit | $30 per visit | |
| Inpatient Hospital Copay | $225 per day for days 1–7; $0 for days 8+ | $175 per day for days 1–5; $0 for days 6+ | |
| Outpatient Hospital Copay | $250 | $150 | |
| Lab Services | $0 copay | $0 copay | |
| X-rays | $15 copay | $5 copay | |
| Emergency Room Visit | $90 copay Waived if admitted | $120 copay Waived if admitted | |
| Ambulance | $225 copay | $150 copay | |
| Many Preventive Wellness Services | $0 copay | $0 copay | |
| Durable Medical Equipment | 20% of cost | 20% of cost | |
| Diabetes Supplies | $0 copay | $0 copay | |
| Routine Eye Exam | $0 copay | $0 copay | |
| Eyewear Allowance | $100 per calendar year | $100 per calendar year | |
| Preventive Dental Allowance | $250 per calendar year | $250 per calendar year | |
| Hearing Exams | $0 copay for routine exam $10 copay for diagnostic exam | $0 copay for routine exam $10 copay for diagnostic exam | |
| Hearing Aids* | $699/$999 copay per hearing aid (one per ear, per year) | $699/$999 copay per hearing aid (one per ear, per year) | |
| Maximum Out-of-Pocket Amount | $5,100 (in-network) | $3,400 (in-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 | |||
| $4 | $3 | ||
| $13 | $8 | ||
| $40 | $40 | ||
| 45% | 45% | ||
| 25% | 33% | ||
| $2 | $2 | ||
| Part D Coverage Gap | You 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 Coverage | You pay the greater of $3.60 for generic drugs and $8.95 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 $3.60 for generic drugs and $8.95 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest. | |
| Blue Advantage | Blue Advantage | |
** 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.
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.
