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  • Menu
  • HOME
  • BCBSRI
    • 2021 Information
      • 2021 Marketing Collateral
      • 2021 Rate Sheets
      • 2021 Health Benefit Summaries
      • 2021 Dental Benefit Summaries
      • 2021 Vision Summaries / Rates
    • 2020 Information
      • 2020 Marketing Collateral
      • 2020 Rate Sheets
      • 2020 Health Benefit Summaries
      • 2020 Dental Benefit Summaries
      • 2020 Vision Benefit Summaries / Rates
      • 2020 Virgin Pulse Wellness
    • 2019 Information
      • 2019 Marketing Collateral
      • 2019 Rate Sheets
      • 2019 Health Benefit Summaries
      • 2019 Dental Benefit Summaries
      • 2019 Vision Benefit Summaries
      • 2019 Recertification
      • 2019 Virgin Pulse - Wellness
      • 2019 Rx Information
    • Enrollment Material
    • Miscellaneous Forms
    • London Health Administrators - CDH Programs
    • Indigo Ancillary Benefits
  • MAILING LIST
  • TESTIMONIALS
  • LINKS
  • CONTACT US
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Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates With Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture

Rates Without Pediatric Dental
Network Blue New England OPTIONS Plans

Network Blue New England Options 100/0 $2000/$4000

Network Blue New England Options 100/0 $5000/$10000

Blue Choice New England Plans

Blue Choice New England 100/80 $1000/$2000

Blue Choice New England 100/80 $2000/$4000

Blue Choice New England 100/80 $3000/$6000

Blue Choice New England 100/80 $4000/$8000

Network Blue New England Plans

Network Blue New England 80/0 $1000/$2000

Network Blue New England 100/0 $1000/$2000

Network Blue New England 100/0 $2000/$4000

Network Blue New England 100/0 $3000/$6000

Network Blue New England 100/0 $4000/$8000

BlueSolutions Plans

BlueSolutions 100/60 $1500/$3000

BlueSolutions 100/60 $1500/$3000 with Copay

BlueSolutions 100/60 $1900/$3800

BlueSolutions 100/60 $3400/$6800

BlueSolutions 100/60 $4000/$8000

BlueSolutions 100/60 $5000/$10000

BlueSolutions 100/60 $6000/$12000

BlueSolutions 100/60 $6750/$13500

VantageBlue Plans

VantageBlue 100/80 500/1000*

VantageBlue 100/80 750/1500*

VantageBlue 100/80 1000/2000*

VantageBlue 100/60 1500/3000*

VantageBlue 100/80 2000/4000

VantageBlue 100/80 2500/5000

VantageBlue 100/80 3000/6000

VantageBlue 100/80 4000/8000

VantageBlue 80/60 1000/2000

VantageBlue 80/60 2000/4000

VantageBlue 80/60 3000/6000

VantageBlue 70/50 2000/4000

VantageBlue 100/80 8150/16300

*These plans include coverage for Acupuncture


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