24K Dual Network
Anthem / Blue Cross Blue Shield
24K Dual Network — Deductible: $0 in-network (Tier 1); Max Out of Pocket: $6,000 / $18,200; Office Copays: $25 / $35; X-Ray & Bloodwork: $40 copay; Advanced Imaging: Copay applies.
Monthly premiums
- Member
- $1,650.00/mo
- Member & Children
- $2,885.00/mo
- Member & Spouse
- $3,455.00/mo
- Member & Family
- $4,340.00/mo
Plan details
- Deductible (Individual)
- $0
- Deductible (Family)
- $0
- Out-of-Pocket Max (Individual)
- $6,000
- Out-of-Pocket Max (Family)
- $18,200
- Primary Care Copay
- $25
- Specialist Copay
- $40
- Urgent Care Copay
- $50
- ER Copay
- $600
Benefits
Deductible
$0 in-network (Tier 1)
Out-of-network: $1,000 / $2,000
Max Out of Pocket
$6,000 / $18,200
Individual / Family
Office Copays
$25 / $40
PCP / Specialist (Tier 1)
X-Ray & Bloodwork
$40 copay
Minor services (in-network)
Advanced Imaging
Copay applies
CT / MRI / PET (in-network)
Emergency Room
$600 copay
Per visit
Urgent Care
$50 copay
Tier 1 (in-network)
Hospital Stay
$500 copay/admission
Facility (Tier 1) + $40 physician
Mental Health
$25 copay
Outpatient; inpatient $500/admission
Maternity
$500 facility · $40 professional
Delivery (Tier 1)
Rx Coverage
Generic $10 / Preferred $50 / Non-Preferred $80
Retail copay per prescription
Dual Network
Northwell Direct + BlueCard PPO
Tier 1 $0 deductible · Tier 2 national
Virtual Care
No charge
CirrusMD 24/7
Referrals
None required
See any specialist
Preventive Care
100% covered
Before deductible
Eligibility
Until age 59 · Must be working
Plan documents
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