SimpliveraCoverage Companion

Premera Blue Cross Preferred Silver 4500

Premera Blue Cross Blue Shield of Alaska · 2026 plan year

Silver
Ind. deductible
$4,000
Family deductible
$8,000
Ind. OOP max
$7,100
Family OOP max
$14,200

Other cost-sharing reduction variants for this plan:

87% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More Premera Blue Cross Blue Shield of Alaska plans in AK

Premera Blue Cross Standard Bronze IIPremera Blue Cross Standard SilverPremera Blue Cross Preferred Gold 1500Premera Blue Cross Preferred Bronze 6350

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$15.00

Specialist

BenefitIn-network
Specialist Visit$55.00

Hospital

BenefitIn-network
Emergency Room Services30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$55.00

Pharmacy

BenefitIn-network
Generic Drugs$18.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$60.00
Specialty Drugs40.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$55.00

Other

BenefitIn-network
Nutritional CounselingNo charge
Orthodontia - AdultNot covered
Abortion for Which Public Funding is Prohibited30.00% Coinsurance after deductible
Accidental Dental30.00% Coinsurance after deductible
Acupuncture$15.00
Allergy Testing30.00% Coinsurance after deductible
Bariatric SurgeryNot covered
Basic Dental Care - AdultNot covered
Basic Dental Care - Child20.00% Coinsurance after deductible
Chemotherapy30.00% Coinsurance after deductible
Chiropractic Care$15.00
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Dental Check-Up for Children10.00%
Diabetes EducationNo charge
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$55.00 Copay after deductible
Hearing Aids20.00%
Hearing Exam$55.00
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infertility TreatmentNot covered
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - Child50.00% Coinsurance after deductible
Massage Therapy$55.00 Copay after deductible
Orthodontia - Child50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$15.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services$55.00 Copay after deductible
Premera-Designated Centers of Excellence ProgramNo charge
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Private-Duty NursingNot covered
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$55.00 Copay after deductible
Rehabilitative Speech Therapy$55.00 Copay after deductible
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for Children$30.00
Routine Foot Care30.00% Coinsurance after deductible
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$55.00
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

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