This plan has in-network and out-of-network coverage for most services. The out-of-network annual deductible and out-of-pocket maximum are double the in-network amount. The amounts listed below apply for individual in-network services only.

Blue Elect Plus POS Small Group Plan options breakdown for 2021
Blue Elect Plus POS
Plan options
Gold $500 Gold $1,000 Gold $2,000 Gold $3,000
Annual deductible (individual / family)
$500 / $1,000 $1,000 / $2,000 $2,000 / $4,000 $3,000 / $6,000
Coinsurance Percentage 30% 20% 20% 20%
Embedded
Coinsurance Maximum
 (individual / family)
$4,500 / $9,000 $3,500 / $7,000 N/A N/A
Out-of-pocket maximum (individual / family)
$8,150 / $16,300 $7,350 / $14,700 $7,350 / $14,700 $8,150 / $16,300
PCP office visit copays $30 $30 $30 $30
Preferred generic pharmacy copays $10 $10 $15 $15

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