Blue Cross® Select HMO Bronze Secure
98185MI0440019
Bronze
HMO
Blue Cross® Select HMO Bronze Secure is a Bronze HMO plan by Blue Care Network of Michigan.
Locations
Blue Cross® Select HMO Bronze Secure is offered in the following counties.
Plan Overview
This is a plan overview for 2025 version of Blue Cross® Select HMO Bronze Secure 98185MI0440019.
| Insurer: | Blue Care Network of Michigan |
| Network Type: | HMO |
| Metal Type: | Bronze |
| HSA Eligible?: | No |
| Plan ID: | 98185MI0440019 |
Cost-Sharing Overview
Blue Cross® Select HMO Bronze Secure offers the following cost-sharing.
Cost-Sharing
Out-of-Network Cost-Sharing
Cost-Sharing Examples
Cost-Sharing
Cost-sharing for Blue Cross® Select HMO Bronze Secure includes your out-of-pocket maximum, your annual deductible, and coinsurance under this plan.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Pocket Maximum: | $9200 per person | $18400 per group |
| Deductible: | $9200 per person | $18400 per group |
| Coinsurance: | 0.00% | |
Out-of-Network Cost-Sharing
Some plans have different cost-sharing out-of-network. The out-of-network cost-sharing for Blue Cross® Select HMO Bronze Secure will be shown below if applicable.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Network Maximum: | per person not applicable | per group not applicable |
| Out-of-Network Deductible: | per person not applicable | per group not applicable |
Cost-Sharing Examples
The cost-sharing for the sample Summary of Benefits & Coverage (SBC) scenarios of having a baby, having diabetes, and having a simple fracture.
| Deductible: | $9,200 |
| Copayment: | $0 |
| Coinsurance: | $0 |
| Limit: | $60 |
| Deductible: | $5,400 |
| Copayment: | $0 |
| Coinsurance: | $0 |
| Limit: | $20 |
| Deductible: | $2,800 |
| Copayment: | $0 |
| Coinsurance: | $0 |
| Limit: | $0 |
Notes:
- Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
- You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Blue Cross® Select HMO Bronze Secure?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904
Plan Features
Blue Cross® Select HMO Bronze Secure offers the following features and referral requirements.
| Wellness Program: | No |
| Disease Program: | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| Notice Pregnancy: | No |
| Referral Specialist: | Yes |
| Specialist Requiring Referral: | All except routine OB/GYN & pediatric visits |
| Plan Exclusions: | |
| Child Only Option?: | Allows Adult and Child-Only |
Network Details
The following network details will help you understand what Blue Cross® Select HMO Bronze Secure covers when you are out of the service area or out of the country.
| Out of Country Coverage: | Yes |
| Out of Country Coverage Description: | Accidential Injury and Emergency Only |
| Out of Service Area Coverage: | Yes |
| Out of Service Area Coverage Description: | Accidential Injury and Emergency Only |
| National Network: | No |
Additional Benefits and Cost-Sharing
Blue Cross® Select HMO Bronze Secure includes the following benefits at the cost sharing rates listed below.
| Service | In-Network Copay / Coinsurance | Out-of-Network Copay / Coinsurance | Limits and Explanation |
|---|---|---|---|
| Primary Care Visit to Treat an Injury or Illness Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Includes virtual, retail health clinic and medical evaluation at an affiliated immunization pharmacy visits. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app, except HSA eligible plans have no charge after deductible. Diagnostic services are not included in the office visit copayment. These services are subject to the plan’s deductible. |
| Specialist Visit Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Referral required. The penalty for not having a referral is denial of payment. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app, except HSA eligible plans have no charge after deductible. Diagnostic services are not included in the office visit copayment. These services are subject to the plan’s deductible. |
| Other Practitioner Office Visit (Nurse, Physician Assistant) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Includes virtual, retail health clinic and medical evaluation at an affiliated immunization pharmacy visits. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app, except HSA eligible plans have no charge after deductible. Diagnostic services are not included in the office visit copayment. These services are subject to the plan’s deductible. |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cosmetic surgery, corrective eye surgery, investigational and experimental procedures. May require prior authorization. |
| Outpatient Surgery Physician/Surgical Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cosmetic surgery, corrective eye surgery, investigational and experimental procedures. May require prior authorization. |
| Hospice Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Housekeeping services. Room and board at an extended care facility or hospice facility for the purposes of delivering Custodial Care. Prior authorization required. The penalty for not having prior authorization is denial of payment. BCN participating hospice programs only. Coverage includes inpatient and outpatient hospice care. |
| Routine Dental Services (Adult) Not Covered | |||
| Infertility Treatment Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Artificial Insemination and In-Vitro Fertilization. Prior authorization required. The penalty for not having prior authorization is denial of payment. |
| Long-Term/Custodial Nursing Home Care Not Covered | |||
| Private-Duty Nursing Not Covered | |||
| Routine Eye Exam (Adult) Covered | No Charge Not Applicable | Not Applicable 100.00% | 1.0 Exam(s) per Year Out of network is paid up to the allowed amount. |
| Urgent Care Centers or Facilities Covered | No Charge after deductible Not Applicable | No Charge after deductible Not Applicable | Urgent Care visits will be covered at non-participating providers for medical emergencies and accidental injuries only. |
| Home Health Care Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Housekeeping Services. Services for the purposes of custodial care. BCN approved providers only. |
| Emergency Room Services Covered | No Charge after deductible Not Applicable | No Charge after deductible Not Applicable | Emergency room visits will be covered at non-participating facilities for medical emergencies and accidental injuries only. Copayment waived if admitted inpatient into the hospital. |
| Emergency Transportation/Ambulance Covered | No Charge after deductible Not Applicable | No Charge after deductible Not Applicable | Transportation for convenience. Includes air and ground transportation. |
| Inpatient Hospital Services (e.g., Hospital Stay) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authorization required. The penalty for not having prior authorization is denial of payment. |
| Inpatient Physician and Surgical Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authorization required. The penalty for not having prior authorization is denial of payment. |
| Bariatric Surgery Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 1.0 Procedure(s) per Lifetime Subject to BCN medical criteria. |
| Cosmetic Surgery Not Covered | |||
| Skilled Nursing Facility Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 45.0 Days per Year Custodial Care. Prior authoriztion required. The penalty for not having prior authorization is denial of payment. BCN participating facilities only. |
| Prenatal and Postnatal Care Covered | No Charge Not Applicable | Not Applicable 100.00% | Cost sharing does not apply for preventive services. Depending on the type of services, a copayment, coinsurance, or deductible may apply. |
| Delivery and All Inpatient Services for Maternity Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authoriztion required. The penalty for not having prior authorization is denial of payment. |
| Mental/Behavioral Health Outpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Copayment applies to provider?s office, virtual visit and applied behavior analysis (ABA) treatment by participating BCN provider and Blue Cross online visit from BCN selected vendor only. Additional services are subject to the plan’s deductible and coinsurance. Prior authorization is not required for outpatient, office and online visits. Prior authorization is required for other outpatient services. |
| Mental/Behavioral Health Inpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authoriztion required. The penalty for not having prior authorization is denial of payment. |
| Substance Abuse Disorder Outpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Copayment applies to provider?s office and virtual visit by participating BCN provider and Blue Cross online visit from BCN selected vendor only. Additional services are subject to the plan’s deductible and coinsurance. Prior authorization is not required for outpatient, office and online visits. Prior authorization is required for other outpatient services. |
| Substance Abuse Disorder Inpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authoriztion required. The penalty for not having prior authorization is denial of payment. |
| Generic Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply. Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
| Preferred Brand Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply. Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
| Non-Preferred Brand Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply. Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
| Specialty Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication Refer to drug list for quantity limits and other exclusions. BCN has contracted with an exclusive pharmacy network for specialty drugs. Call the customer service phone number on the back of your ID card for the pharmacy?s phone number or location nearest to you. If you obtain your specialty drugs from any other pharmacy, you are responsible for the total cost. Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
| Outpatient Rehabilitation Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 30.0 Visit(s) per Year Prior authoriztion required.The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year. |
| Habilitation Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 30.0 Visit(s) per Year Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year. |
| Chiropractic Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 30.0 Visit(s) per Year Spinal manipulation limit is not combined with Occupational Therapy and Physical Therapy; limit includes services provided by an osteopathic provider. |
| Durable Medical Equipment Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Excludes bath, exercise and deluxe equipment and comfort and convenience items. Prescription is required. Rental and purchase limited to basic equipment. Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Breast pumps are covered in full when preauthorized. |
| Hearing Aids Not Covered | |||
| Imaging (CT/PET Scans, MRIs) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Prior authoriztion required. The penalty for not having prior authorization is denial of payment. |
| Preventive Care/Screening/Immunization Covered | Not Applicable 0.00% | Not Applicable 100.00% | Care and services not defined as preventive under PPACA. May require prior authorization. The penalty for not having prior authorization is denial of payment. You may have to pay for services that aren?t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for. |
| Routine Foot Care Not Covered | |||
| Acupuncture Not Covered | |||
| Weight Loss Programs Covered | No Charge Not Applicable | Not Applicable 100.00% | Obesity screening at physician’s office only. |
| Routine Eye Exam for Children Covered | No Charge Not Applicable | Not Applicable 100.00% | 1.0 Exam(s) per Year Out of network is paid up to the allowed amount. A child is defined as a member up to age 19. |
| Eye Glasses for Children Covered | No Charge Not Applicable | Not Applicable 100.00% | 1.0 Item(s) per Year Out of network is paid up to the allowed amount. A child is defined as a member up to age 19. |
| Dental Check-Up for Children Not Covered | |||
| Rehabilitative Speech Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 30.0 Visit(s) per Year Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year. |
| Rehabilitative Occupational and Rehabilitative Physical Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 30.0 Visit(s) per Year Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year. |
| Well Baby Visits and Care Covered | No Charge Not Applicable | Not Applicable 100.00% | Quantity limits based on PPACA. |
| Laboratory Outpatient and Professional Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | May require prior authorization. The penalty for not having prior authorization is denial of payment. |
| X-rays and Diagnostic Imaging Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | May require prior authorization. The penalty for not having prior authorization is denial of payment. |
| Basic Dental Care – Child Not Covered | |||
| Orthodontia – Child Not Covered | |||
| Major Dental Care – Child Not Covered | |||
| Basic Dental Care – Adult Not Covered | |||
| Orthodontia – Adult Not Covered | |||
| Major Dental Care – Adult Not Covered | |||
| Abortion for Which Public Funding is Prohibited Not Covered | |||
| Transplant Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Subject to BCN medical criteria. BCN designated facility only. |
| Accidental Dental Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Accidental injury and emergency only. |
| Dialysis Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Allergy Testing Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | In network only if at a physican’s office. |
| Chemotherapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Radiation Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Diabetes Education Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Follow Medicare guidelines. |
| Prosthetic Devices Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | BCN approved providers only. Limited to the basic items; replacement is limited to items that cannot be repaired or modified |
| Infusion Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | BCN approved providers only. |
| Treatment for Temporomandibular Joint Disorders Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Dental and orthodontic services, treatment, prosthesis and appliances related to TMJ. Prior authorization required. The penalty for not having prior authorization is denial of payment. Coverage includes medical care or services to treat dysfunction or TMJ resulting from a medical cause or Injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental x-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis. |
| Nutritional Counseling Covered | No Charge Not Applicable | Not Applicable 100.00% | Dietician Services. |
| Reconstructive Surgery Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Covered only when medically necessary. |
| Gender Affirming Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cosmetic surgery, investigational and experimental procedures. May require prior authorization. |
| Non-Preferred Generic Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply. Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
| Non-Preferred Specialty Drugs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication Refer to drug list for quantity limits and other exclusions. BCN has contracted with an exclusive pharmacy network for specialty drugs. Call the customer service phone number on the back of your ID card for the pharmacy?s phone number or location nearest to you. If you obtain your specialty drugs from any other pharmacy, you are responsible for the total cost. Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumer?s deductible, cost-sharing or out of pocket maximum |
Free Preventive Services
There is no copayment or coinsurance for any of the following Blue Cross® Select HMO Bronze Secure preventive services. This is true even if you haven’t met your yearly deductible.
Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.
Preventive Care Benefits for All Adults
Preventive Care Benefits for Women
Preventive Care Benefits for Children
Preventive Care Benefits for All Adults
Preventive care benefits for adults
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults age 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
Preventive Care Benefits for Women
Services for pregnant women or women who may become pregnant
- Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Birth control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- Maternal depression screening for mothers at well-baby visits
- Preeclampsia prevention and screening for pregnant women with high blood pressure
- Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Syphilis screening
- Expanded tobacco intervention and counseling for pregnant tobacco users
- Urinary tract or other infection screening
Other covered preventive services for women
- Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause
- Breast cancer genetic test counseling (BRCA) for women at higher risk
- Breast cancer mammography screenings
- Every 2 years for women 50 and over
- As recommended by a provider for women 40 to 49 or women at higher risk for breast cancer
- Breast cancer chemoprevention counseling for women at higher risk
- Cervical cancer screening
- Pap test (also called a Pap smear) for women age 21 to 65
- Chlamydia infection screening for younger women and other women at higher risk
- Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
- Domestic and interpersonal violence screening and counseling for all women
- Gonorrhea screening for all women at higher risk
- HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use
- Sexually transmitted infections counseling for sexually active women
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits to get recommended services for all women
Preventive Care Benefits for Children
Coverage for children’s preventive health services
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children: Age 0 to 17 years
- Bilirubin concentration screening for newborns
- Blood pressure screening for children: Age 0 to 17
- Blood screening for newborns
- Depression screening for adolescents beginning routinely at age 12
- Developmental screening for children under age 3
- Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Fluoride supplements for children without fluoride in their water source
- Fluoride varnish for all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns; and regular screenings for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly for all children
- Hematocrit or hemoglobin screening for all children
- Hemoglobinopathies or sickle cell screening for newborns
- Hepatitis B screening for adolescents at higher risk
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
Immunizations for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenza type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu shot)
- Measles
- Meningococcal
- Mumps
- Pneumococcal
- Rubella
- Rotavirus
Lead screening for children at risk of exposure
Obesity screening and counseling
- Oral health risk assessment for young children from 6 months to 6 years
- Phenylketonuria (PKU) screening for newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis: Age 0 -17
- Vision screening for all children
- Well-baby and well-child visits
Additional Resources
Below are additional resources for Blue Cross® Select HMO Bronze Secure including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.
| Summary of Benefits: | Summary of Benefits Link |
| Plan Brochure: | Plan Brochure Link |
| Formulary: | Formulary Link |
| Premium Payment Website: | Premium Payment Link |
Ready to sign up for Blue Cross® Select HMO Bronze Secure?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904