| | When you use Preferred Providers, you pay: | When you use Non-preferred Providers, you pay: |
| Combined Deductible Options | Option A: $3,500 per member or $7,000 per family Option B: $5,000 per member or $10,000 per family Option C: $7,500 per member or $15,000 per family Option D: $10,000 per member or $20,000 per family |
| Office Visits | $30 Co-payment | Deductible plus 30% coinsurance |
| Inpatient General Hospital Services | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
| Outpatient General Hospital Services | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
| Emergency Room Services | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
| Ambulance Services | Deductible plus 20% coinsurance | Deductible plus 20% coinsurance |
| Private Duty Nursing | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
| Durable Medical Equipment | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
| Home Care | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance |
Out-of-pocket Maximums (After you pay this amount in one calendar year, BCBSVT covers services at 100% for the rest of the year.) | Option A: $9,500 per member or $19,000 per family Option B: $11,000 per member or $22,000 per family Option C: $13,500 per member or $27,000 per family Option D: $17,000 per member or $34,000 per family | Option A: $12,500 per member or $25,000 per family Option B: $14,000 per member or $28,000 per family Option C: $18,750 per member or $37,500 per family Option D: $23,500 per member or $47,000 per family |
| | When you use Network Providers, you pay: | When you use Non-network providers, you pay: |
| Office Visits for Mental Health and Substance Abuse Services | $30 Co-payment | No coverage |
| Inpatient Mental Health and Substance Abuse Treatment Services | Deductible plus 20% coinsurance | No coverage |
| Prescription Drugs | - $100 separate deductible, then
- 40% for each generic prescription,
- 50% for each prescription on our Preferred Brand-name drug list, or
- 60% for each Non-preferred prescription, with an out-of-pocket limit of $5,000 in a calendar year.
| No coverage |