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)

$49.00 per month

Enroll Now

Blue Advantage
Premier (PPO)

$159.00 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.

**SilverSneakers® Fitness Program is provided by Tivity Health Inc.™ ©2017, an independent company with subsidiaries and affiliates worldwide. All rights reserved.

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