Premera Blue Cross Blue Shield of Alaska

Plan Network

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Plan Coverage
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Doctor Visits

Primary Care
First 4 visits free
$30
Specialist
$30
Preventative Care
$0

Prescriptions

Generic Drugs
$10
Brand Drugs
$40
Brand Drugs (Non-Preferred)
$80
Specialty Drugs
20%

Hospital

Emergency Room
20% after deductible
Ambulance
20% after deductible
Hospital Stay (Facility)
$0 per Day after deductible
Hospital Stay (Physician)
20% after deductible
Outpatient Procedure (Facility)
20% after deductible
Outpatient Procedure (Physician)
20% after deductible

Pregnancy

Delivery
20% after deductible
Well Baby Visits
$0

Mental Health

Outpatient Services
20%
Psychiatric Hospital Stay
20% after deductible

Diagnostics / Labs / Imaging

X-Rays
20%
CT Scans, Pet Scans and MRIs
20% after deductible
Lab Tests
20%

Free Preventative Care

If you use an in-network doctor, this plan will provide all preventative care services at no cost.

List of covered services

Out of Network

If you use out-of-network providers under this plan, you may have to pay more or even full price. Out of Network care doesn't count towards your deductible and maximum out-of-pocket.