Blue Local Gold All Copay A | $30 PCP | $10 Tier 1 Rx | with Atrium Health
Blue Cross and Blue Shield of NC · 2027 plan year
Gold
- Ind. deductible
- No deductible
- Family deductible
- $0
- Ind. OOP max
- $12,000
- Family OOP max
- $24,000
Compare with other Gold 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 3
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $490 | $490 |
| 21 | $641 | $769 |
| 30 | $728 | $873 |
| 40 | $819 | $983 |
| 50 | $1,145 | $1,374 |
| 60 | $1,740 | $2,088 |
| 64 and over | $1,923 | $2,308 |
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 | $1,500.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $2500.00 Copay per Stay |
| Outpatient Surgery Physician/Surgical Services | No charge |
| Urgent Care Centers or Facilities | $60.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $10.00 |
| Non-Preferred Brand Drugs | $120.00 |
| Preferred Brand Drugs | $60.00 |
| Specialty Drugs | $220.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $2,500.00 |
| Mental/Behavioral Health Outpatient Services | $30.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $2,000.00 |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Bariatric Surgery | $2,500.00 |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | $60.00 |
| Chemotherapy | $60.00 |
| Chiropractic Care | $60.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $2,500.00 |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $30.00 |
| Dialysis | $60.00 |
| Durable Medical Equipment | $60.00 |
| Emergency Transportation/Ambulance | $200.00 |
| Eye Glasses for Children | $200.00 |
| Habilitation Services | $60.00 |
| Hearing Aids | $200.00 |
| Home Health Care Services | $60.00 |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | $200.00 |
| Infertility Treatment | $60.00 |
| Infusion Therapy | $60.00 |
| Inpatient Physician and Surgical Services | No charge |
| Laboratory Outpatient and Professional Services | $30.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | $60.00 |
| Nutritional Counseling | No charge |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | $60.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $60.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $2,000.00 |
| Outpatient Rehabilitation Services | $60.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | $60.00 |
| Prosthetic Devices | $200.00 |
| Radiation | $60.00 |
| Reconstructive Surgery | $2,500.00 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $60.00 |
| Rehabilitative Speech Therapy | $60.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $60.00 |
| Sex-Trait Modification | $2,000.00 |
| Skilled Nursing Facility | $60.00 Copay per Day |
| Substance Abuse Disorder Inpatient Services | $2,500.00 |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| Tier 2 Rx | $30.00 |
| Transplant | $2,500.00 |
| Treatment for Temporomandibular Joint Disorders | $60.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $60.00 |
Plan rules
Service area
This plan covers 1 geographic area.
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