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My BlueSM |
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Individual Blue |
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Value Blue |
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Young
Adult Blue |
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Flexible Blue 1500 |
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Flexible Blue 2500 |
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Medicare Plus |
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Prescription Blue |
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Dental |
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Community BlueSM PPO |
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Comparison Form |
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Plan 1 |
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Plan 2 |
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Plan 3 |
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Plan 4 |
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Plan 12-0% |
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Plan 12-20% |
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Plan 14-0% |
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Plan 14-20% |
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Plan 15-0% |
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Plan 15-20% |
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Plan 16 |
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Plan 17 |
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Flexible BlueSM |
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FB 2 |
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FB 2 with Drugs |
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FB 2 with Drug Rider XBPPE |
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FB 2 with
20%-40% Copay, $1000-$2000CM |
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FB 2 with
20%-40% Copay, $2000-$4000CM |
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FB 2 with
30%-50% Copay, $1000-$2000CM |
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FB 2 with
30%-50% Copay, $2000-$4000CM |
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FB 3 |
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FB 3 with Drugs |
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FB 3 with Drug Rider XBPPE |
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FB
3 with 20%-40% Copay, $1000-$2000CM |
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FB
3 with 20%-40% Copay, $2000-$4000CM |
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FB
3 with 30%-50% Copay, $1000-$2000CM |
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FB
3 with 30%-50% Copay, $2000-$4000CM |
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FB 4 |
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FB 4 with Drugs |
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FB 4 with Drug Rider XBPPE |
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FB
4 with 20%-40% Copay, $1000-$2000CM |
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FB
4 with 20%-40% Copay, $2000-$4000CM |
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FB
4 with 30%-50% Copay, $1000-$2000CM |
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FB
4 with 30%-50% Copay, $2000-$4000CM |
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FB Preventive Care
and Mammography |
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Comparison Form |
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One Subscriber Group |
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Plan A |
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Deductible Package 3 |
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BCN OSG Rx |
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Community Blue PPO8 |
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Prescription BlueSM |
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Blue Advantage
Rx |
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$10/$20 Copay |
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$10/$40 Copay |
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$10/$40
Closed Formulary |
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$10/$60 Copay |
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$15/$30 Copay |
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$15/$50 Copay |
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$15/40%
Closed Formulary |
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$15/$50/50% ($70 min/$100 max) Open Formulary |
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$15/$50
Closed Formulary |
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$20/$60/50% ($80 min/$100 max) Open Formulary |
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$15/$30/$60 Copay |
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Blue Care Network |
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Basic |
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BCN 5 & 10 Comparison |
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Blue Elect Self-Referral Option |
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Blue
Elect Self-Referral OptionSM 01 |
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Blue
Elect Self-Referral OptionSM 02 |
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Healthy Blue LivingSM Package 1 |
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Healthy Blue LivingSM Package 2 |
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Healthy Blue LivingSM Package 3 |
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Healthy Blue LivingSM Package 4 |
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Healthy Blue LivingSM Package 5 |
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Healthy Blue LivingSM Package 6 |
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Health Blue LivingSM Group Brochure |
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Health Blue LivingSM Member Brochure |
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Health Blue LivingSM Guide to a Healthier Lifestyle |
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Health Blue LivingSM Member Qualification Form |
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Healthy Blue Living Synopsis |
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Healthy Blue Living Plan Descriptions |
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Dual Option Guidelines |
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Healthy Blue Living Rx 5-30 |
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Healthy Blue Living Rx 10-20 |
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Healthy Blue Living Rx 10-40 |
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Healthy Blue Living Rx 15-50 |
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BCN Deductible Package Ded1 |
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BCN Deductible Package Ded2 |
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BCN Deductible Package Ded3 |
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BCN Prescription Drug |
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$10/$20 Copay |
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1x Mail Order |
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2x
DED Mail Order |
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$10/$20/$40 Copay |
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1x Mail Order |
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2x Mail Order |
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$5/$15/$25 |
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1x Mail Order |
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2x Mail Order |
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$5/$30 |
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1x Mail Order |
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2x
DED Mail Order |
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2x Mail Order |
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$5/$50 Copay |
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1x Mail Order |
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2x
DED Mail Order |
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2x Mail Order |
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50% Copay |
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1x Mail Order |
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2x Mail Order |
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$10/$40
Copay |
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1x Mail Order |
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2x
DED Mail Order |
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2x Mail Order |
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BCBSM Traditional Plus Dental |
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Plan 1 |
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Plan 2 |
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Plan 3 |
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Plan 4 |
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Plan 5 |
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Plan 6 |
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Plan 7 |
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Blue
Dental ChoiceSM - Voluntary Options |
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Plan 2 |
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Plan 3 |
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Community Dental |
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Plan 2 |
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Plan 3 |
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Plan 4 |
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Plan 5 |
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VSP Vision |
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VSP 12 |
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VSP 24 |
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Blue
VisionSM
Choice - Voluntary Option |
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Blue
VisionSM Choice |
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BCBSM Open Associations and Chambers
Listing |
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Access the
Association document |
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BCBSM Medicare Supplemental |
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Supplemental Coverage |
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