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Silver S01S, Network S
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Silver S01S, Network S

Overview
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Silver S01S, Network S is an individual health health plan issued by BlueCross BlueShield of Tennessee 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 Hawkins county, Tennessee.

What Type of Health Plan Is This?

This plan is an EPO plan, which is also known as an "Exclusive Provider Organization." An EPO is a managed care plan where services are covered so long as the the hospitals, dentists, and other health providers in the plan's network are used.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
BlueCross BlueShield of Tennessee
Plan ID
14002TN0400100
Coverage area
Hawkins County, Tennessee
Phone
Local Phone: 1-423-535-5600
Toll-Free: 1-800-565-9140
TTY:
Plan type
EPO
Coverage type
Medical deductible
$500
Out-of-pocket maximum
$7,000
Generic drug co-pay
50% Coinsurance after deductible
Preferred brand drug co-pay
50% Coinsurance after deductible
Primary care physician visit cost
50% Coinsurance after deductible
Specialist doctor visit cost
50% Coinsurance after deductible
Doctor Visits
Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Emergency Room Visit 50% Coinsurance after deductible
Inpatient Facility Visit 50% Coinsurance after deductible
Inpatient Physician Visit 50% Coinsurance after deductible
Prescription Drugs
Generic Drugs 50% Coinsurance after deductible
Preferred Brand Drugs 50% Coinsurance after deductible
Non-preferred Brand Drugs 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $500
Medical Maximum Out Of Pocket (Individual) $7,000
Medical Deductible (Family) $1,000
Medical Maximum Out Of Pocket (Family) $14,000
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 0-14 401
Premium Child Age 18 478
Premium Adult Individual Age 21 524
Premium Adult Individual Age 27 549
Premium Adult Individual Age 30 595
Premium Adult Individual Age 40 670
Premium Adult Individual Age 50 936
Premium Adult Individual Age 60 1,423
Premium Couple 21 1,048
Premium Couple 30 1,190
Premium Couple 40 1,340
Premium Couple 50 1,873
Premium Couple 60 2,846
Couple+1 child, Age 21 1,450
Couple+1 child, Age 30 1,591
Couple+1 child, Age 40 1,741
Couple+1 child, Age 50 2,274
Couple+2 children, Age 21 1,851
Couple+2 children, Age 30 1,993
Couple+2 children, Age 40 2,143
Couple+2 children, Age 50 2,675
Couple+3 or more Children, Age 21 2,252
Couple+3 or more Children, Age 30 2,394
Couple+3 or more Children, Age 40 2,544
Couple+3 or more Children, Age 50 3,077
Individual+1 child, Age 21 925
Individual+1 child, Age 30 996
Individual+1 child, Age 40 1,071
Individual+1 child, Age 50 1,337
Individual+2 children, Age 21 1,326
Individual+2 children, Age 30 1,397
Individual+2 children, Age 40 1,472
Individual+2 children, Age 50 1,739
Individual+3 or more children, Age 21 1,728
Individual+3 or more children, Age 30 1,798
Individual+3 or more children, Age 40 1,873
Individual+3 or more children, Age 50 2,140
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