Blue Local Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | with Atrium Health
Blue Cross and Blue Shield of NC · 2027 plan year
Silver
- Ind. medical deductible
- $3,500
- Rx deductible (separate)
- $200
- Family deductible
- $7,000
- Ind. OOP max
- $12,000
- Family OOP max
- $24,000
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Silver plans in NC
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Blue Cross and Blue Shield of NC plans in NC
Blue Advantage Silver Preferred | 3 Free PCP | $15 Tier 1 Rx | Integrated | Nationwide DoctorsBlue Advantage Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Nationwide DoctorsBlue Advantage Gold Premier A | 3 Free PCP | $10 Tier 1 Rx | Nationwide DoctorsBlue Advantage Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Nationwide DoctorsBlue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | HSA Eligible | Nationwide Doctors
Monthly premiums by age
Rating Area 5
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $548 | $548 |
| 21 | $717 | $860 |
| 30 | $814 | $977 |
| 40 | $916 | $1,100 |
| 50 | $1,281 | $1,537 |
| 60 | $1,946 | $2,335 |
| 64 and over | $2,151 | $2,581 |
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 | $45.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $95.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 50.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 50.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $95.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $70.00 Copay after deductible |
| Preferred Brand Drugs | $35.00 Copay after deductible |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $45.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 50.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $95.00 |
| Bariatric Surgery | 50.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 50.00% Coinsurance after deductible |
| Chemotherapy | 50.00% Coinsurance after deductible |
| Chiropractic Care | $95.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 50.00% Coinsurance after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $45.00 |
| Dialysis | 50.00% Coinsurance after deductible |
| Durable Medical Equipment | 50.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Eye Glasses for Children | 50.00% |
| Habilitation Services | $95.00 |
| Hearing Aids | 50.00% Coinsurance after deductible |
| Home Health Care Services | 50.00% Coinsurance after deductible |
| Hospice Services | 50.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 50.00% Coinsurance after deductible |
| Infertility Treatment | $95.00 |
| Infusion Therapy | 50.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 50.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 50.00% 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 |
| Orthodontia - Child | 50.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $95.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 50.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 50.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 50.00% Coinsurance after deductible |
| Prosthetic Devices | 50.00% Coinsurance after deductible |
| Radiation | 50.00% Coinsurance after deductible |
| Reconstructive Surgery | 50.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $95.00 |
| Rehabilitative Speech Therapy | $95.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $95.00 |
| Sex-Trait Modification | 50.00% Coinsurance after deductible |
| Skilled Nursing Facility | 50.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 50.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $45.00 |
| Tier 2 Rx | $25.00 Copay after deductible |
| Transplant | 50.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | $95.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 50.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 3 geographic areas.
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