BlueValue Gold $30 PCP Copay (Standardized plan)
Blue Cross Blue Shield of North Dakota · 2026 plan year
Gold
- Ind. deductible
- $2,000
- Family deductible
- $4,000
- Ind. OOP max
- $8,200
- Family OOP max
- $16,400
Compare with other Gold plans in ND
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Blue Cross Blue Shield of North Dakota plans in ND
BlueDirect Silver 80 HSA Eligible ($3500 Deductible / $5 Preventive Drug List)BlueDirect Bronze 100 HSA Eligible ($8000 Deductible / $5 Preventive Drug List)BlueEssential Catastrophic 100 HSA Eligible $10600 DeductibleBlueDirect Gold 90 HSA Eligible ($2600 Deductible / $5 Preventive Drug List)BlueValue Silver $40 PCP Copay (Standardized plan)
Monthly premiums by age
The same in all 4 areas this plan covers.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $395 | $395 |
| 21 | $516 | $619 |
| 30 | $585 | $703 |
| 40 | $659 | $791 |
| 50 | $921 | $1,106 |
| 60 | $1,400 | $1,680 |
| 64 and over | $1,547 | $1,857 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $60.00 |
| Preferred Brand Drugs | $30.00 |
| Specialty Drugs | $250.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $30.00 |
Other
| Benefit | In-network |
|---|---|
| Chemotherapy | 25.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Orthodontia - Child | 50.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 25.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | 25.00% Coinsurance after deductible |
| Bariatric Surgery | 25.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 50.00% Coinsurance after deductible |
| Chiropractic Care | $30.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Dental Check-Up for Children | $40.00 |
| Diabetes Education | 25.00% |
| Dialysis | 25.00% Coinsurance after deductible |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | 25.00% Coinsurance after deductible |
| Habilitation Services | $30.00 |
| Hearing Aids | 25.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | 25.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 25.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Nutritional Counseling | No charge |
| Orthodontia - Adult | Not covered |
| Outpatient Rehabilitation Services | $30.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 25.00% Coinsurance after deductible |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30.00 |
| Rehabilitative Speech Therapy | $30.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $40.00 |
| Routine Foot Care | 25.00% Coinsurance after deductible |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 25.00% Coinsurance after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 1 geographic area.
Open enrollment coming up?
Get notified when it opens — we'll remind you so you don't miss your window.