BlueSolutions for HSA Direct 6000 *

Mary, a 42-year-old stay-at-home mom & Mark a 44-year-old plumber

Mark is self-employed and not eligible for an employer health plan. Mary and Mark have two children,ages 10 and 12.

Health status:
Mary has type 2 diabetes; Mark has high cholesterol and obesity.

Exercise:
None.

Healthcare utilization:
Annual well visits for the entire family; Routine lab work; Three primary care visits;Diabetes foot and eye exams; One urgent care visit; One monthly generic medication for high cholesterol; Two monthly tier 2 medications for diabetes; One generic antibiotic prescription.

Costs &
Incentives
BlueSolutions for HSA
Direct 3000/6000

Medical Costs

Annual Well Visiit with lab work,
mammogram,and gyn exam

No cost
3-PCP Visits $336**(applies to deductible)
($112/visit)
Diabetes foot and eye exams $230**(applies to deductible)
Urgent care $225**(applies to deductible)
Pharmacy Costs  

Generic med (cholesterol)

$29**(applies to deductible)
Tier 2 diabetes(2) $236**(applies to deductible)
$2,832 annually
Generic
antibiotic
$29**(applies to deductible)
Monthly Premium $582.70 (Preferred)
$753.28 (Basic)
Annual Premium $6,992.40 (Preferred)
$9,039.36 (Basic)
Wellness Reward –10% N/A
Wellness Incentive N/A
TOTAL Estimated Annual Cost with
Insurance
$10,673.40 (Preferred)
$12,720.36 (Basic)

* The example provided above is only a summary of benefits provided by the plan based on the hypothetical circumstances of the participant. Other exceptions, reductions, and limitations may also apply to your benefits. The preferred premium described above is for individuals or families who satisfy certain plan requirements, and the basic premium is for participants who do not satisfy those requirements. Your actual premium will be determined based on your application answers and the results of our medical underwriting. For complete benefit details, please see the subscriber agreement for the plan.

**As a BCBSRI member, you benefit from discounts we negotiate with our in-network providers. This means that when you need care, providers charge you less than what they would charge you if you did not have health insurance with BCBSRI. These payments are your anticipated copayment as a percent of the provider’s negotiated charge.

 

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