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BlueSelect Gold Balance
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BlueSelect Gold Balance

Overview
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BlueSelect Gold Balance is an individual health health plan issued by Blue Cross Blue Shield of Wyoming and is available for the year 2019. This health plan is offered by the federal government through HealthCare.gov and the Affordable Care Act (ACA).

Where Do I Need to Live to Quality for this Plan?

This plan is available for qualifying individuals who live in Uinta county, Wyoming.

What Type of Health Plan Is This?

This plan is a PPO plan, which is also known as a "Preferred Provider Organization." In this type of insurance plan, you can choose to receive care from doctors, hospitals, and other providers who are in-network or out-of-network. You pay less if you use in-network providers. In a PPO plan, you can visit any doctor without getting a referral.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
Blue Cross Blue Shield of Wyoming
Plan ID
11269WY0070024
Coverage area
Uinta County, Wyoming
Phone
Local Phone: 1-307-634-1393x2949
Toll-Free: 1-800-851-2227
TTY: 1-800-696-4710
Plan type
PPO
Coverage type
Medical deductible
$2,000
Out-of-pocket maximum
$7,900
Generic drug co-pay
$5
Preferred brand drug co-pay
$50
Primary care physician visit cost
$30 and 20% Coinsurance after deductible
Specialist doctor visit cost
20% Coinsurance after deductible
Doctor Visits
Primary Care Visit $30 and 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Emergency Room Visit $500 Copay with deductible and 40% Coinsurance after deductible
Inpatient Facility Visit 40% Coinsurance after deductible
Inpatient Physician Visit 20% Coinsurance after deductible
Prescription Drugs
Generic Drugs $5
Preferred Brand Drugs $50
Non-preferred Brand Drugs 20% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $2,000
Medical Maximum Out Of Pocket (Individual) $7,900
Medical Deductible (Family) $4,000
Medical Maximum Out Of Pocket (Family) $15,800
Drug Deductible
Drug Deductible (Individual) Included in Medical
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) Included in Medical
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 100.00%
Premium Child Age 0-14 433
Premium Child Age 18 517
Premium Adult Individual Age 21 566
Premium Adult Individual Age 27 593
Premium Adult Individual Age 30 642
Premium Adult Individual Age 40 723
Premium Adult Individual Age 50 1,011
Premium Adult Individual Age 60 1,536
Premium Couple 21 1,132
Premium Couple 30 1,285
Premium Couple 40 1,447
Premium Couple 50 2,022
Premium Couple 60 3,073
Couple+1 child, Age 21 1,565
Couple+1 child, Age 30 1,718
Couple+1 child, Age 40 1,880
Couple+1 child, Age 50 2,455
Couple+2 children, Age 21 1,998
Couple+2 children, Age 30 2,151
Couple+2 children, Age 40 2,313
Couple+2 children, Age 50 2,889
Couple+3 or more Children, Age 21 2,432
Couple+3 or more Children, Age 30 2,585
Couple+3 or more Children, Age 40 2,746
Couple+3 or more Children, Age 50 3,322
Individual+1 child, Age 21 999
Individual+1 child, Age 30 1,075
Individual+1 child, Age 40 1,156
Individual+1 child, Age 50 1,444
Individual+2 children, Age 21 1,432
Individual+2 children, Age 30 1,509
Individual+2 children, Age 40 1,590
Individual+2 children, Age 50 1,877
Individual+3 or more children, Age 21 1,865
Individual+3 or more children, Age 30 1,942
Individual+3 or more children, Age 40 2,023
Individual+3 or more children, Age 50 2,310
Reference
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  • HealthCare.gov. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov
  • The 'metal' categories: Bronze, Silver, Gold & Platinum. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plans-categories
  • Health insurance plan & network types: HMOs, PPOs, and more. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plan-types