SimplyBluePlus Plans

In-Network

Each plan features the doctors, hospitals and other health care providers who participate in BlueNetwork S. Please use the Find A Doctor tool on this site to see if your doctors participate in BlueNetwork S before applying for one of the plans above.

*Out-of-Pocket Max includes deductible

Coinsurance applies to maximum allowable charges. Out-of-pocket maximums for in-network and out-of-network covered services are separate and do not combine. Lifetime maximum benefit - $5,000,000. Any balance of charges (between billed charges and maximum allowable charge) does not apply toward your deductible or out-of-pocket maximum.

SimplyBluePlus Offers Additional Benefits
In addition to the benefits offered by SimplyBlue plans, SimplyBluePlus plan options offer you more benefits to help you stay well and budget your health care dollars.

$30 Copay for Office Visits

• Medically necessary treatment for illness or injuries at your network physician’s office (Limit two per calendar year).
• Covered preventive services and screenings (no limits on the number of visits).

$15 Copay for Generic Prescription Drugs

• Must use an RX03 network pharmacy.
• Limited to $125 per calendar quarter (This limit is calculated using the cost of the generic drug less your copay.)
• Brand-name drugs are not covered.

Covered Wellness and Preventive Services for Adults and Children Age Six and Older (Subject to $30 copay and $300 annual payment limit). Well care exams are covered including the following services:

• Childhood immunizations.
• Blood pressure screening.
• Periodic cholesterol screening.
• Colorectal cancer screenings.
• Flu shot.
• Tetanus-diphtheria (Td) booster.
• Pneumoccocal immunization.
• Recommended adult immunizations and immunizations not received in childhood.
• Other prescribed x-rays and lab screenings associated with preventive care.
• Vision and hearing screening performed by the physician during the preventive health exam.
• Immunizations needed for foreign travel.

Exclusions are those wellness services not recommended by the guidelines of the
U.S. Task Force on Preventive Care and the medical policy of BlueCross BlueShield
of Tennessee.

Calculate your monthly premium for SimplyBlue. [ 0.1 MB ]