Blue Cross Blue Shield Emergency Room Copay

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In-Network (PPO benefit) -
You pay:
Out-of-Network (Non-PPO benefit)* -
You pay:
Preventive Care Nothing for covered preventive screenings, immunizations and services 35% of our allowance
Physician Care

$25 for primary care
$35 for specialists

35% of our allowance
Virtual Doctor Visits by Teladoc®

$0 for first 2 visits
$10 all additional visits

N/A
Urgent Care Center Accidental Injury: $0
Medical Emergency: $30 copay
Accidental Injury: $0
Medical Emergency: 35% of our allowance
Prescription Drugs Preferred Retail Pharmacy:
Tier 1 (Generics): $7.50 copay1
Tier 2 (Preferred brand): 30% of our allowance
Tier 3 (Non-preferred brand): 50% of our allowance
Tier 4 (Preferred specialty): 30% of our allowance
Tier 5 (Non-preferred specialty): 30% of our allowance
Mail Service Pharmacy:
Tier 1 (Generics): $15 copay1
Tier 2 (Preferred brand): $90 copay
Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy2:
Tier 4 (Preferred specialty): $65 copay
Tier 5 (Non-preferred specialty): $85 copay
Retail Pharmacy:
45% of our allowance
Mail Service Pharmacy:
Not covered
Specialty Pharmacy:
Not covered
Maternity Care $0 copay Pre-/postnatal professional care: 35% of our allowance
Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance
Outpatient facility care: 35% of our allowance
Hospital Care Inpatient (Precertification is required): $350 per admission
Outpatient: 15% of our allowance
Inpatient (Precertification is required): $450 per admission copay, plus 35% of our allowance
Outpatient: 35%
of our allowance
Surgery 15% of our allowance35% of our allowance
ER (accidental injury) $0 within 72 hours

Nothing for covered services

ER (medical emergency) 15% of our allowance15% of our allowance
Lab work (such as blood tests) 15% of our allowance35% of our allowance
Diagnostic services (such as sleep studies, X-rays, CT scans) 15% of our allowance35% of our allowance
Chiropractic Care

$25 per treatment; up to 12 visits per year

35% of our allowance; up to 12 visits per year

Dental Care The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) 35% of our allowance
Rewards Program

Earn $50 for completing the Blue Health Assessment.3

Earn up to $120 for completing three eligible Online Health Coach goals.3

Earn $50 for completing the Blue Health Assessment.3

Earn up to $120 for completing three eligible Online Health Coach goals.3

Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20.
We apologize for any inconvenience.

Blue cross blue shield nc emergency room copay

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association Note: The cost estimates are based on an approximate grouping of services and reflects2007 HMO cost data trended to Q3 2009. Specificmember experience will vary depending on type, intensity, and number of specificservices. Should I go to the emergency room or urgent care? Who is this for? Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65. What if you get sick or injured and your doctor's office is closed? Understanding your options now can save you time later when you might need immediate care. Beginning January 1, 2017, (and December 24, 2016 for certain members), the hospital Emergency Room (ER) copayment will increase for some of the Horizon Blue Cross Blue Shield of New Jersey plans offered under the State Health Benefits Program (SHBP). New identification cards are not being issued as a result of these ER copayment changes.

Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 2am - 5am Saturday, October 20.
We apologize for any inconvenience.

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