BlueSolutions for HSA Direct
4100/8200
This plan offers a high level of coverage once you meet your deductible, with the added benefit of an optional health savings account (HSA) to pay for medical expenses. You’ll have access to the national network of doctors (across all 50 states), labs, and hospitals.
- Full coverage for many preventive services, like an annual physical, when you use a doctor in the national network
- You receive tax advantages when you open an HSA
- MedsYourWay® prescription savings program—no coupons or discount cards needed—and all covered prescription purchases accumulate toward your deductible (if applicable) and out-of-pocket maximum.*
- Includes dental and vision coverage for dependents under the age of 19
- $0 copays for programs on quitting smoking, weight loss, and managing conditions like diabetes
- Earn up to $250 (both subscriber and covered spouse) in wellness rewards
- Member discounts with Blue 365 on gyms, nutrition services, fitness trackers, and more health and lifestyle brands
- View benefit information and manage your HSA on myBCBSRI
What's covered
See if your doctor is in the network
Search providers
Coverage
In-Network You Pay
Medical Coverage
Preventive services
$0
Primary care provider (PCP) office visit when affiliated with a patient-centered medical home (PCMH)
20% after deductible
PCP not affiliated with a PCMH
20% after deductible
Doctors Online (designated telemedicine provider)
20% after deductible
Retail clinic
20% after deductible
Specialist visit
20% after deductible
Acupuncture treatment
20% after deductible (12 visits per year)
Urgent care center
20% after deductible
Emergency room
20% after deductible
Diagnostic laboratory tests
20% after deductible
X-rays
20% after deductible
High-end radiology (MRI, PET, CAT scan, etc.
20% after deductible
Inpatient hospital
20% after deductible
Pediatric Vision Eyeware (Dependents under 19)
Collection prescription glasses, lenses, and collection contact lenses
20% after deductible
Pediatric Dental (Dependent under 19)
Oral exams, cleanings, X-rays, fluoride treatments, sealants, and space maintainers
$0 after deductible
All other covered dental services
50% after deductible
Coverage
In-Network You Pay
Tier 1 (Preferred Generic)
$10 after deductible
Tier 2 (Non-preferred Generic)
$30 after deductible
Tier 3 (Preferred Brand)
$50 after deductible
Tier 4 (Non-Preferred Brand)
$75 after deductible
Tier 5 (Specialty)
20% after deductible
*MedsYourWay is not insurance. It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services. Ask your pharmacy if they participate in MedsYourWay before filling your prescription.