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

2019 Plan Benefits

Blue Advantage
Complete (PPO)

$0 per month

Enroll Now

Blue Advantage
Premier (PPO)

$159 per month

Enroll Now
Primary Care Doctor Visit Copay$10 per visit$5 per visit
Specialist Visit Copay$40 per visit$30 per visit
Inpatient Hospital Copay$215 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$200 copay$150 copay
Preventive Services$0 copay$0 copay
Durable Medical Equipment20% of cost20% 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 (up to 2) per calendar year$699/$999 copay per hearing aid (up to 2) per calendar year
Maximum Out-of-Pocket Amount$4,900$3,400
Blue Advantage Includes Prescription Drug Coverage
Part D Deductible
Tiers 1, 2 and 6$0$0
Tiers 3, 4 and 5$100 annual$0
Part D Drug Copays/Coinsurance at Preferred Pharmacies
Tier 1
 – 
Preferred Generic
$3$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
$2$2
Part D Coverage GapYou pay 37% of generic drug costs and 25% of brand-name drug costs.You pay 37% of generic drug costs and 25% of brand-name drug costs.
Part D Catastrophic CoverageYou pay the greater of $3.40 for generic drugs and $8.50 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 $3.40 for generic drugs and $8.50 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)

$159 per month

Enroll Now

** SilverSneakers® Fitness Program is provided by Tivity Health Inc.™ ©, an independent company with subsidiaries and affiliates worldwide. 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.