BlueDirect Gold 90 HSA Eligible $2600 Deductible
Blue Cross Blue Shield of North Dakota · 2027 plan year
GoldHSA eligible
- Ind. deductible
- $2,600
- Family deductible
- $5,200
- Ind. OOP max
- $4,300
- Family OOP max
- $8,600
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
Monthly premiums by age
The same in all 4 areas this plan covers.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $447 | $447 |
| 21 | $584 | $701 |
| 30 | $663 | $795 |
| 40 | $746 | $895 |
| 50 | $1,043 | $1,251 |
| 60 | $1,584 | $1,901 |
| 64 and over | $1,751 | $2,102 |
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 | 10.00% Coinsurance after deductible |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | 10.00% Coinsurance after deductible |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 10.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 10.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 10.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | 10.00% Coinsurance after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | 10.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | 10.00% Coinsurance after deductible |
| Preferred Brand Drugs | 10.00% Coinsurance after deductible |
| Specialty Drugs | 20.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 10.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 10.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 10.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | 10.00% Coinsurance after deductible |
| Bariatric Surgery | 10.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 10.00% Coinsurance after deductible |
| Chemotherapy | 10.00% Coinsurance after deductible |
| Chiropractic Care | 10.00% Coinsurance after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 10.00% Coinsurance after deductible |
| Dental Check-Up for Children | 10.00% Coinsurance after deductible |
| Diabetes Education | 10.00% Coinsurance after deductible |
| Dialysis | 10.00% Coinsurance after deductible |
| Durable Medical Equipment | 10.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 10.00% Coinsurance after deductible |
| Eye Glasses for Children | 10.00% Coinsurance after deductible |
| Habilitation Services | 10.00% Coinsurance after deductible |
| Hearing Aids | 10.00% Coinsurance after deductible |
| Home Health Care Services | 10.00% Coinsurance after deductible |
| Hospice Services | 10.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 10.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 10.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 10.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 10.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | 50.00% Coinsurance after deductible |
| 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) | 10.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 10.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 10.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 10.00% Coinsurance after deductible |
| Radiation | 10.00% Coinsurance after deductible |
| Reconstructive Surgery | 10.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 10.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 10.00% Coinsurance after deductible |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | 10.00% Coinsurance after deductible |
| Routine Foot Care | 10.00% Coinsurance after deductible |
| Skilled Nursing Facility | 10.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 10.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 10.00% Coinsurance after deductible |
| Transplant | 10.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 10.00% Coinsurance after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 10.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 1 geographic area.
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