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Blue Advantage Overview

Blue Advantage Plans Include:

  • Comprehensive Medical Coverage
  • Prescription Drug Coverage
  • Comprehensive Dental
  • Vision Exams & Eyewear
  • Hearing Exams & Hearing Aids
  • SilverSneakers® Fitness Membership
  • Choice of plans, including $0 premium option
  • Built-in prescription drug coverage
  • Statewide provider network with 100% of Alabama hospitals and over 90% of doctors
  • No referral required for network specialists, doctors or hospitals
  • In and out of nework covered services
  • $0 copay for an annual routine vision and hearing exam
  • Significant discounts on hearing aids through TruHearing®
  • $100 eyewear and starting at $500 allowance for preventative and comprehensive dental per calendar year
  • SilverSneakers® fitness membership
  • $0 copay for preventive care, most immunizations, and lab services
  • Air medical transportation
  • 24-Hour nurses hotline
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Comprehensive Medical Coverage

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Prescription Drug Coverage

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Comprehensive Dental

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Vision Exams & Eyewear

Hearing Exam Icon

Hearing Exams & Hearing Aids

Sneaker Icon

Silver Sneakers® Membership

Blue Advantage makes it easy to stay healthy and save money

  • Choice of plans, including $0 premium option
  • Built-in prescription drug coverage
  • Statewide provider network with 100% of Alabama hospitals and over  90% of doctors
  • No referral required for network specialists, doctors or hospitals
  • In and out of nework covered services
  • $0 copay for an annual routine vision and hearing exam
  • Significant discounts on hearing aids through TruHearing®**
  • $100 eyewear and starting at $500 allowance for preventative and comprehensive dental per calendar year
  • SilverSneakers® fitness membership* Learn More >
  • $0 copay for preventive care, most immunizations, and lab services
  • Air medical transportation
  • 24-Hour nurse hotline
Pie Chart with 90% filled

More than 90% of all Alabama physicians are in our network.

Pie Chart with 100% filled

Along with 100% of all Alabama hospitals!

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Blue Advantage

Complete (PPO)

$0 per month

Blue Advantage

Premier (PPO)

$170 per month

Primary Care Doctor Visit Copay $5 copay per visit $5 per visit
Specialist Visit Copay $40 per visit $25 per visit
Inpatient Hospital Copay $225 copay per day for days 1–7;
You pay nothing per day for days 8-90;
$0 copay for days 91 and after
$175 copay per day for days 1–5;
You pay nothing per day for days 6-90;
$0 copay for days 91 and after
Outpatient Hospital Copay $250 copay $150 copay
Lab Services $0 copay $0 copay
X-rays $15 copay $5 copay
Emergency Room Visit $90 copay
Waived if admitted
$120 copay
Waived if admitted
Ambulance $275 copay $150 copay
Many Preventive Wellness Services $0 copay $0 copay
Durable Medical Equipment 20% of cost 20% of cost
Diabetic Supplies* $0 copay $0 copay
Eye Exams $0 copay for routine exam & $30 copay for diagnostic exam $0 copay for routine exam & $25 copay for diagnostic exam
Eyewear Allowance $100 per calendar year $100 per calendar year
Preventive & Comprehensive Dental Allowance $500 per calendar year $750 per calendar year
Hearing Exams $0 copay for routine exam
$10 copay for diagnostic exam
$0 copay for routine exam
$10 copay for diagnostic exam
Hearing Aids $699/$999 copay per hearing aid
(one per ear, per year)
$699/$999 copay per hearing aid
(one per ear, per year)
Maximum Out-of-Pocket Amount $5,100 (in-network) $3,400 (in-network)
PREFERRED Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 - Preferred Generic $4 $3
Tier 2 - Generic $13 $8
Tier 3 - Preferred Brand $40 $40
Tier 4 - Non-Preferred Brand 45% 45%
Tier 5 - Specialty Tier 25% 33%
STANDARD Cost-Sharing Pharmacy Copays / Coinsurance
Tier 1 - Preferred Generic $11 $10
Tier 2 - Generic $20 $15
Tier 3 - Preferred Brand $47 $47
Tier 4 - Non-Preferred Brand 50% 50%
Tier 5 - Specialty Tier 25% 33%
Coverage Gap Phase Once the TOTAL prescription annual spending exceeds $4,130 and YOUR spending is below $6,550 you pay 25% of generic drug costs and 25% of brand-name drug costs. Once the TOTAL prescription annual spending exceeds $4,130 and YOUR spending is below $6,550 you pay 25% of generic drug costs and 25% of brand-name drug costs.
Catastrophic Coverage Phase Once YOUR out-of-pocket spending on prescriptions reaches $6,550 you pay the greater of $3.70 for generic drugs and $9.20 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest. Once YOUR out-of-pocket spending on prescriptions reaches $6,550 you pay the greater of $3.70 for generic drugs and $9.20 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest.

*Only Ascensia and LifeScan products are preferred with a $0 copay for diabetic test strips and glucometers at the pharmacy and through mail-order home delivery.

 

Disclaimers SS and TH

*SilverSneakers is a registered trademark of Tivity Health, Inc. © 2019 Tivity Health, Inc. All rights reserved.

** All content ©2020 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark of TruHearing, Inc. Three follow-up visits must be used within one year after the date of initial purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees.

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