Blue Cross of Idaho Health Service, Inc. - SAHA Southwest Bronze Connect 7300
Primary Care Visit
$40 Copay
60% Coinsurance after deductible
Specialist Visit
$150 Copay
60% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
$40 Copay
60% Coinsurance after deductible
Preventive Care/Screening/Immunization
No Charge
60% Coinsurance after deductible
Laboratory Outpatient and Professional Services
40% Coinsurance after deductible
60% Coinsurance after deductible
X-rays and Diagnostic Imaging
40% Coinsurance after deductible
60% Coinsurance after deductible
Imaging (CT/PET scans, MRIs)
$500 Copay
40% Coinsurance after deductible
40% Coinsurance after deductible
$500 Copay
60% Coinsurance after deductible
60% Coinsurance after deductible
Generic Drugs
$25 Copay
$25 Copay
Preferred Brand Drugs
$30 Copay after deductible
$30 Copay after deductible
Non-Preferred Brand Drugs
$50 Copay after deductible
$50 Copay after deductible
Specialty Drugs
50% Coinsurance after deductible
50% Coinsurance after deductible
Outpatient Facility Fee
40% Coinsurance after deductible
60% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Emergency Room Services
$600 Copay after deductible
$600 Copay after deductible
Emergency Transportation/Ambulance
40% Coinsurance after deductible
60% Coinsurance after deductible
Urgent Care
$40 Copay
60% Coinsurance after deductible
Inpatient Hospital Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Inpatient Physician and Surgical Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
$40 Copay
60% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services
$40 Copay
60% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Prenatal and Postnatal Care
40% Coinsurance after deductible
60% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
40% Coinsurance after deductible
60% Coinsurance after deductible
Home Healthcare Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Outpatient Rehabilitation Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Habilitation Services
40% Coinsurance after deductible
60% Coinsurance after deductible
Skilled Nursing Facility
40% Coinsurance after deductible
60% Coinsurance after deductible
Durable Medical Equipment
40% Coinsurance after deductible
60% Coinsurance after deductible
Hospice Services
No Charge
60% Coinsurance after deductible
Chiropractic Care
40% Coinsurance after deductible
60% Coinsurance after deductible
Acupuncture
Not covered
Not covered
Rehabilitative Speech Therapy
40% Coinsurance after deductible
60% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy
40% Coinsurance after deductible
60% Coinsurance after deductible
Well Baby Visits and Care
No Charge
60% Coinsurance after deductible
Allergy Testing
40% Coinsurance after deductible
60% Coinsurance after deductible
Diabetes Education
$20 Copay
60% Coinsurance after deductible
Nutritional Counseling
No Charge
60% Coinsurance after deductible
Eye Exam for Children
No Charge
50% Coinsurance
Eye Glasses for Children
No Charge
50% Coinsurance
Accidental Dental
40% Coinsurance after deductible
60% Coinsurance after deductible
Basic Dental Care (Adult)
Not covered
Not covered
Basic Dental Care (Child)
Not covered
Not covered
Dental Check Up (Child)
Not covered
Not covered
Major Dental Care (Adult)
Not covered
Not covered
Major Dental Care (Child)
Not covered
Not covered
Orthodontia (Adult)
Not covered
Not covered
Orthodontia (Child)
Not covered
Not covered
Routine Dental Services (Adult)
Not covered
Not covered