BlueSelect for Individuals & Families - 2024 Archives - Blue Cross Blue Shield of Wyoming

Basic Plans – 2027

	Bronze Plan
HSA Eligible Learn More	No
Participant deductible	$8,550
Family deductible	$17,100
Participant out-of-pocket	$8,550
Family out-of-pocket	$17,100
Coinsurance BCBSWY Pays Participant Pays	100% 0%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care Copay	Subject to the deductible & coinsurance
Prescription Drugs Tier 1: Generic Drugs Tier 2: Preferred Brand drugs	Subject to the deductible & coinsurance Subject to the deductible & coinsurance
Summary of Benefits and Coverage (SBC)	View SBC »

Based on certain income requirements, you may qualify for assistance, through government subsidies, with your monthly premiums.

Find important information on your prescriptions, including how to select a pharmacy, request prescription benefits, and more.

	Gold Plan	Silver Plan
HSA Eligible Learn More	No	No
Participant deductible	$750	$2,500
Family deductible	$1,500	$5,000
Participant out-of-pocket	$7,900	$7,900
Family out-of-pocket	$15,800	$15,800
Coinsurance BCBSWY Pays Participant Pays	75% 25%	60% 40%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care Copay	$30	$45
Prescription Drugs
Tier 1: Generic Drugs	$5 copay	$5 copay
Tier 2: Preferred Brand drugs	$20 copay	$50 copay
Summary of Benefits and Coverage (SBC)	View SBC	View SBC

	Gold Plan	Silver Plan
HSA Eligible Learn More	No	No
Participant deductible	$1,000	$4,000
Family deductible	$2,000	$8,000
Participant out-of-pocket	$7,900	$7,900
Family out-of-pocket	$15,800	$15,800
Coinsurance BCBSWY Pays Participant Pays	80% 20%	75% 25%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care Copay	$30	$45
Prescription Drugs Tier 1: Generic Drugs Tier 2: Preferred Brand drugs	$5/$0 copay $20/$10 copay	$5/$0 copay $50/$25 copay
Summary of Benefits and Coverage (SBC)	View SBC	View SBC

	Bronze Plan
	Single Plan	Family Plan
HSA Eligible Learn More	Yes	Yes
Participant deductible	$4,500	NA
Family deductible	NA	$9,000
Participant out-of-pocket	$6,750	$6,750
Family out-of-pocket	NA	$13,500
Coinsurance BCBSWY Pays Participant Pays	50% 50%	50% 50%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care Copay	Subject to the deductible & coinsurance	Subject to the deductible & coinsurance
Prescription Drugs Tier 1: Generic Drugs Tier 2: Preferred Brand drugs	Subject to the deductible & coinsurance	Subject to the deductible & coinsurance
Summary of Benefits and Coverage (SBC)	View SBC »	View SBC »

	Gold Plan		Silver Plan		Bronze Plan
	Professional Services	Hospital Services	Professional Services	Hospital Services	Professional Services	Hospital Services
HSA Eligible Learn More	No		No		No
Participant deductible	$500	$1,500	$1,500	$4,500	$3,500	$7,000
Family deductible	$1,000	$3,000	$3,000	$9,000	$7,000	$14,000
Participant out-of-pocket	$7,900		$7,900		$7,900
Family out-of-pocket	$15,800		$15,800		$15,800
Coinsurance
BCBSWY Pays	80%	60%	75%	55%	70%	50%
Participant Pays	20%	40%	25%	45%	30%	50%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care
Copay	$30	N/A	$40	N/A	Subject to the deductible & coinsurance	N/A
Prescription Drugs
Tier 1: Generic Drugs Tier 2: Preferred Brand drugs	$5 copay $50 copay		$5 copay $100 copay		Subject to the professional services deductible & coinsurance
Summary of Benefits and Coverage (SBC)	View SBC		View SBC		View SBC

	Gold Plan	Silver Plan
HSA Eligible Learn More	No	No
Participant deductible	$1,000	$4,000
Family deductible	$2,000	$8,000
Participant out-of-pocket	$7,900	$7,900
Family out-of-pocket	$15,800	$15,800
Coinsurance BCBSWY Pays Participant Pays	80% 20%	75% 25%
Preventive Care	Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care Copay	$30	$45
Prescription Drugs Tier 1: Generic Drugs Tier 2: Preferred Brand drugs	$5/$0 copay $20/$10 copay	$5/$0 copay $50/$25 copay
Summary of Benefits and Coverage (SBC)	View SBC	View SBC