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BC Life & Health RightPlan PPO 40 with generic prescription drug coverage (PE48) Apply Now Rates by county Some counties have special rates by Zip code
Lifetime Maximum
In-Network	$5,000,000.00
Out-of-Network	$5,000,000.00
Out of Pocket Maximum
In-Network	$7,500.00 In and Out of Network Combined
Out-of-Network	$7,500.00 In and Out of Network Combined
Annual Deductible
In-Network	$0
Out-of-Network	$0
Office Visits
In-Network	$40 CoPay
Out-of-Network	50% of negotiated fee plus 100% of charges in excess of negotiated fee ¹
Professional Services
In-Network	40% of negotiated fee
Out-of-Network	50% of negotiated fee plus 100% of charges in excess of of negotiated fee
Inpatient Hospital Services (Includes organ and tissue transplants)
In-Network	40% of negotiated fee plus $400 copay per day/4 day max per admission ^2,4,5
Out-of-Network	All charges except $650 per day
Outpatient Hospital Services/Ambulatory Surgical Center
In-Network	40% of negotiated fee plus $400 copay per outpatient surgery admit ^2,4,5
Out-of-Network	All charges except $380 per day
Emergency Care
In-Network	40% of negotiated fee ³
Out-of-Network	40% of C&R for first 48 hours plus 100% of charges in excess of C&R. After 48 hours all charges in excess of $650 per day ^3,7
Maternity
In-Network	Not Covered
Out-of-Network	Not Covered
Preventive Care/HealthyCheck Center
In-Network	$25 or $75 option
Out-of-Network	Not covered
Preventive Care
In-Network	$40 office visit plus 40% of negotiated fee for well-baby and well-child thru age 6 $40 office visit plus 40% of negotiated fee for Covered Services other than the Office Visit for Annual Pap exam Breast exams Mammogram testing and appropriate screeni
Out-of-Network	All charges in excess of 50% of negotiated fee for well-baby and well-child thru age 6 All Charges in excess of 50% of negotiated fee
Ambulance Service
In-Network	40% of negotiated fee
Out-of-Network	All charges in excess of 50% of negotiated fee
Physical Therapy, Occupational Therapy/Chiro
In-Network	40% of negotiated fee; limited to 12 visits/year, participating and non-participating combined
Out-of-Network	All charges except $25 per visit
Acupuncture/Acupressure
In-Network	All charges except $25 per visit; limited to 24 visits/year, participating and non-participating combined
Out-of-Network	All charges except $25 per visit; limited to 24 visits/year, participating and non-participating combined
Prescription Drug Benefit
In-Network	$10 Generic CoPay, RightPlan Generic Prescription Formulary ⁶ Click here to view the RightPlan generic prescription formulary
Out-of-Network	50% of Drug Limited Fee schedule less the copay as stated for participation pharmacies

Please Note: When locating a provider, PPO plans are also referred to as Prudent Buyer1Non-participating charges in excess of the negotiated fee will not be paid.2$500 admission charge for admit to Participating (tier II) Hospital Same benefits for BlueCard providers3Additional $100 copay for PPO Plans applies for each emergency room visit (waived if admitted as inpatient).4Once OOP max is met, $400 copayment will not be required to remainder of that Year5$400 CoPay as explained in Hospital In-Network inpatient/outpatient benefits6Members on RightPlan PPO 40 with No Prescription Drug Coverage and RightPlan PPO 40 with Generic Only Prescription Drug Coverage can access Blue Cross Pharmacy discounts when filling a prescription for a non-covered drug. Members must present the Blue Cross member ID card when they have their prescription filled.

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Right Plan 40 with Generic Prescription Coverage Rate Areas by County

Right Plan 40 Rates

Rates by county

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