SilverSneakers

Fitness Program Included**
What is this?

This plan includes all you need to stay healthy and save money:

  • Access to a statewide network
    Over 95% of doctors and 98% of all Alabama hospitals
  • Freedom to choose your doctor or specialist from our extensive, statewide network
  • NO referrals needed to see specialists
  • Prescription drug coverage
    No need to enroll in a separate drug plan
  • $0 copay for preventive services, immunizations and lab services
  • Eyewear allowance - $100 per calendar year
  • Some plans available with a $0 monthly premium
    Learn how ›

2018 Plan Benefits for

County

Blue Advantage
Complete (PPO)

$49 per month

Enroll Now

Blue Advantage
Premier (PPO)

$159 per month

Enroll Now
Primary Care Doctor Visit Copay
Primary Care Doctor Visit Copay $10 $5
Specialist Visit Copay
Specialist Visit Copay $40 $30
Inpatient Hospital Copay
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
Outpatient Hospital Copay $250 $150
Lab Services
Lab Services $0 copay $0 copay
X-rays
X-rays $15 copay $5 copay
Emergency Room Visit
Emergency Room Visit $80 copay $100 copay
Ambulance
Ambulance $200 copay $150 copay
Preventive Services
Preventive Services $0 copay $0 copay
Durable Medical Equipment
Durable Medical Equipment 20% of cost 20% of cost
Diabetes Supplies
Diabetes Supplies $0 copay $0 copay
Routine Eye Exam
Routine Eye Exam $0 copay $0 copay
Eyewear Allowance
Eyewear Allowance $100 per calendar year $100 per calendar year
Hearing Exam/Hearing Aids
Hearing Exam/Hearing Aids $45 copay for routine exam

$699/$999 copay per hearing aid (up to 2) per calendar year
$45 copay for routine exam

$699/$999 copay per hearing aid (up to 2) per calendar year
Maximum Out-of-Pocket Amount
Maximum Out-of-Pocket Amount $5,000 $3,400
Included Prescription Drug Coverage
Included Prescription Drug Coverage
Part D Deductible
Part D Deductible
Tiers 1, 2 and 6
Tiers 1, 2 and 6 $0 $0
Tiers 3, 4 and 5
Tiers 3, 4 and 5 $150 annual $0
Part D Drug Copays/Coinsurance
Part D Drug Copays/Coinsurance
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic $4 $4
Tier 2 – Generic
Tier 2 – Generic $20 $12
Tier 3 – Preferred Brand
Tier 3 – Preferred Brand $47 $47
Tier 4 – Non-Preferred Brand
Tier 4 – Non-Preferred Brand 50% 50%
Tier 5 – Specialty Tier
Tier 5 – Specialty Tier 25% 33%
Tier 6 – Select Care Drugs
Tier 6 – Select Care Drugs $2 $2
Part D Coverage Gap
Part D Coverage Gap You pay 44% of generic drug costs and 35% of brand-name drug costs.
Part D Catastrophic Coverage
Part D Catastrophic Coverage You pay the greater of $3.35 for generic drugs and $8.35 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest.

Blue Advantage
Complete (PPO)

$49 per month

Enroll Now

Blue Advantage
Premier (PPO)

$159 per month

Enroll Now

** SilverSneakers® Fitness Program is provided by Tivity Health Inc.™ ©2017, 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. Contact the plan 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 network 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.

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