Blue Cross Blue Shield Health Insurance Plans for Virginia,East of Route 123, inluding the town of Vienna and the City of Fairfax.
*(This includes the area in North Virginia closest to DC, like;
-Alexandria, Arlington, Pohick, Pohic Estates, Chapel Acres, Five Forks, Avon Forest, Mt. Vernon, Ft Belvoir, Springfield, Annandale, Dunn Loring)
 Get Instant Blue Preferred Virginia PPO Quotes
Benefit summaries are listed below and should not be used in place of detailed company benefit disclosures. Benefits listed are based on In-Network benefits and services. Out of network benefits are subject to a higher deductible and Coinsurance. Only those benefits listed in company policy contracts are binding. |
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BluePreferred
Underwritten
(VA)
100 / 90 |
BluePreferred
Underwritten
(VA)
300 / 80 |
BluePreferred
Underwritten
(VA)
300 / 90 |
BluePreferred
Underwritten
(VA)
500 / 80 |
BluePreferred
Underwritten
(VA)
750 / 80 |
BluePreferred
Underwritten
(VA)
2500 / 80 |
| Plan Summary |
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| Plan Type |
PPO |
| Office Visit |
$25, no Deductible |
| Individual Deductible |
$100 |
$300 |
$500 |
$750 |
$2,500 |
| Coinsurance |
10% |
20% |
10% |
20% |
| Out-of-Pocket Maximum |
$2,500 |
$3,500 |
$5,000 |
| Lifetime Maximum |
Unlimited |
| Preventive Care |
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| Well Child Care |
Covered in Full through age 18, no Deductible |
| Routine Check-up |
$25, no Deductible |
| Annual GYN Exam |
$25, no Deductible |
| Annual Vision Eye Exam |
$10, no Deductible (in network) |
| Mammography Screening Visits |
Covered in Full |
| Prostate Screening Visits |
Covered in Full |
| Outpatient |
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| Physician Office Visit for Illness |
$25, no Deductible |
| Emergency Room |
$50 copay, then 10% after Deductible |
$50 copay, then 20% after Deductible |
$50 copay, then 10% after Deductible |
$50 copay, then 20% after Deductible |
| Lab/X-Ray |
10% after Deductible |
20% after Deductible |
10% after Deductible |
20% after Deductible |
| Outpatient Surgery |
10% after Deductible |
20% after Deductible |
10% after Deductible |
20% after Deductible |
| Inpatient |
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| Hospitalization |
10% after Deductible |
20% after Deductible |
10% after Deductible |
20% after Deductible |
| Prescription Drugs* |
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| Coverage Details |
Separate Individual $100 deductible; $10 Generic copay / $25 Preferred Brand copay / $45 Non-Preferred Brand Copay; $1,500 Annual Benefit Maximum |
| Extended Maternity |
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For an additional $126 a month, you will receive the following benefits for maternity care: |
| Prenatal / Postnatal Visits |
10% after Deductible |
20% after Deductible |
10% after Deductible |
20% after Deductible |
| Inpatient |
10% after Deductible |
20% after Deductible |
10% after Deductible |
20% after Deductible |
| Vision |
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| Coverage Details |
Optional: One annual exam for $10; up to 30% savings on frames & lenses from network providers |
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Exclusions / Limitations |
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If you and/or any of your dependents meet certain criteria, you may be qualified for health insurance without medical underwriting or pre-existing condition waiting periods. Close this window and scroll down to see available HIPAA products. |
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*Prescription drug benefits are subject to separate deductibles, copayments and maximums. Generics must be chosen when available or an additional expense will be incurred. Self-injectable drugs are covered at a 50% coinsurance up to a $75 maximum. |
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Not all services and procedures are covered by your benefits contract. This plan summary is for comparison purposes only and does not create rights not given through the benefit plan. If you use a provider who does not participate with any BlueCross and BlueShield plan, you will be reponsible for any applicable deductible, copayment, and coinsurance plus amounts over the Allowed Benefit. |
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