Blue Plus®
IN-NETWORK BENEFITS BLUE PLUS METRO MN
Plan numbers* 258/458 (Bronze) 253/453 (Silver) 254/455 (Gold)
Deductible
• Single
• Family

$6,650
$13,300

$3,500
$10,500

$900
$2,700
Compatible with HSA Yes Yes No
Coinsurance 0% 15% 20%
Out-of-pocket maximum
• Single
• Family

$6,650
$13,300

$6,650
$13,300

$6,650
$13,300
Visits
• Health care provider or
   urgent care clinic
• Specialist
• Retail clinic
• E-visit
0% after the deductible 15% after the deductible 20% after the deductible
Preventive care 0% (no deductible) 0% (no deductible) 0% (no deductible)
Prescription drugs
• Preferred generic
• Preferred brand
• Specialty
• Non-preferred

0% after the deductible
0% after the deductible
0% after the deductible
No coverage

15% after the deductible
15% after the deductible
15% after the deductible
No coverage

$20 copay
20% after the deductible
20% after the deductible
No coverage
* Plan numbers in the 200 series are available off-exchange, plan numbers in the 400 series are available through MNsure.

For plans with more than one person (family plan), no one member will exceed the single deductible amount listed above. Also, eligible costs incurred by all covered family members count toward satisfying the family deductible.
Your out-of-pocket costs depend on the network status of your provider.
Lowest out-of-pocket costs: in-network providers
Higher out-of-pocket costs: out-of-network participating providers
Highest out-of-pocket costs: out-of-network nonparticipating providers
Note: In most cases, care you receive outside of Minnesota, other than with providers in your plan’s network, will go toward your out-of-network benefit. You will pay more for these services.
Generally, you are responsible for the difference between Blue Plus’ allowed amount and the amount billed by nonparticipating providers. This is in addition to any applicable deductible, copay or coinsurance. Benefit payments are calculated on Blue Plus’ allowed amount, which is typically lower than the amount billed by the provider.
This is only a summary. The contract and benefit booklet include complete details of what is and isn’t covered. Services not covered include routine adult eye exams and eyewear, custodial care, bariatric surgery, infertility treatment, hearing aids for adults, items primarily used for a nonmedical purpose, over-the-counter drugs (except as specified in the benefit booklet), nutritional supplements, services that are cosmetic, experimental, not medically necessary, or covered by workers’ compensation or no-fault auto insurance. Each health care provider is an independent contractor and not our agent. Nonparticipating providers do not have contracts with Blue Cross and Blue Shield of Minnesota. Benefits are effective January 1, 2018.
Plan Highlights
HSA Bronze $6650 Plan 258
HSA Silver $3500 Plan 253
Gold $900 Plan 254
 
Rates and Calculator
Blue Plus® Metro MN offers access to providers in and around the Twin Cities. 2018.
The Blue Plus Metro MN plan features the Allina Health System. It’s a top-rated system based on patient satisfaction and quality of care. In addition, you’ll have:
  • Access to primary and specialty care providers
  • Preventive benefits covered with no deductible
  • Online tools that empower you to take charge of your health

Health plans are available for you based on where you live.
Published service area maps.
2018 Ind ACO Service Map 2018 Non-Grandfathered Map 2018 Ind Product Map
BLUE PLUS METRO MN NETWORK

Minnesota Map
Metro Area Map

Counties in the Allina Health Network include:
Anoka, Brown, Carver, Chisago, Dakota, Hennepin, Isanti, Kanabec, McLeod, Nicollet, Ramsey, Scott, Sherburne, Sibley, Washington, Wright.
ALLINA HEALTH HOSPITALS
Abbott Northwestern Hospital
Buffalo Hospital
Cambridge Medical Center
District One Hospital
Mercy Hospital
New Ulm Medical Center
Owatonna Hospital
Phillips Eye Institute
Regina Hospital
St. Francis Regional Medical Center
United Hospital
Mercy Hospital-Unity Campus
PARTNER HOSPITALS
Children’s Minnesota
Cuyuna Regional Medical Center
FirstLight Health System
Glencoe Regional Health Services
Hutchinson Health
Ridgeview Medical Center
Ridgeview Sibley Medical Center
River’s Edge Hospital
Riverwood Healthcare Center