Network:PPODeductible:$5,500Coinsurance:0%Max Out of Pocket:$6,000
Key Benefits Include:
Essential Health Benefits | HSA Qualified | Pharmacy
X Metal Level
Bronze Plan
Monthly Cost -- U Add

Summary

Overview

  • Qualified high deductible (QHD) plan to help keep monthly costs low but you’ll pay higher out-of-pocket costs when you get care. Tie your plan with a health savings account (HSA) for tax-free savings
  • Prescription drug benefits with low or no copays after deductible is met
  • No out-of-pocket costs for preventive care
  • The largest PPO network of doctors and hospitals—with the lowest out-of-pocket costs for care from in-network doctors and hospitals
  • Coverage anywhere in the U.S. at the same cost for care as if you were at home
  • Rewards for your wellness—you could earn a $25 gift card for staying well
  • Exclusive wellness discounts on fitness classes, nutrition counseling, massages, restaurants and more
  • Access to your own personal health coach and 24/7 access to registered nurses—so you’ll have the support you need to stay healthy, anytime

Coverage Additions

: Health Savings Account
Personal Savings Account for Future Medical Expenses

Other Insurance Options

Health Plan Benefits

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General Benefits

  • HSA Qualified Yes
  • In-Network Deductible (Medical) $5,500
  • In-Network Deductible (Rx) included with medical
  • In-Network Medical Coinsurance 0%
  • In-Network Out-of-Pocket Maximum (Medical + Rx) $6,000
  • Out-of-Network Coinsurance Percentage 50%
  • Out-of-Network Deductible $6,000
  • Out-of-Network Out-of-Pocket Maximum $10,000
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Additional Coverage

  • Chiropractic Care No charge after deductible, 20 visit maximum per benefit period limited to age 13 and up
  • Durable Medical Equipment No charge after deductible
  • Prosthetic Devices No charge after deductible
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Ambulatory Patient Services

  • PCP Cost Share No charge after deductible
  • Specialist Cost Share No charge after deductible
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Emergency Services

  • Emergency Room Copay No charge after deductible
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Hospitalization

  • Home Health Care Services No charge after deductible, 60 visits per benefit period
  • Inpatient Hospital Services (Hospital Stay) No charge after deductible
  • Inpatient Physician & Surgical Services No charge after deductible
  • Skilled Nursing Facility No charge after deductible, 120 days per benefit period
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Laboratory Services

  • Imaging (CT/PET Scans & MRIs) No charge after deductible
  • Lab Outpatient & Professional Services No charge after deductible
  • X-rays & Diagnostic Imaging No charge after deductible
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Maternity & Newborn Care

  • Delivery and All Inpatient Services for Maternity Care No charge after deductible
  • Prenatal & Postnatal Care No charge
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Mental Health & Substance Use Disorder Services

  • Mental/Behavioral Health Outpatient Services No charge after deductible
  • Substance Abuse Disorder Inpatient Services No charge after deductible
  • Substance Abuse Disorder Outpatient Services No charge after deductible
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Pediatric Services, Oral & Vision Care

  • Eye Glasses for Children No charge after deductible
  • Routine Eye Exam No charge after deductible
  • Routine Eye Exam for Children No charge after deductible
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Prescription Drugs

  • Rx Tier 0 Deductible $0 Retail/$0 Mail
  • Rx Tier 1 Generic Deductible $25 Retail/$50 Mail
  • Rx Tier 2 Preferred Brand Drugs Deductible $50 Retail/$125 Mail
  • Rx Tier 3 Non-Preferred Brand Drugs Deductible $75 Retail/$225 Mail
  • Rx Tier 4 Specialty High-Cost Drugs Deductible $75
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Preventive / Wellness Services & Chronic Disease Management

  • Preventive Care/Screening/Immunization No charge
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Rehabilitative & Habilitative Services and Devices

  • Occupational & Physical Therapy No charge after deductible, 30 visit maximum per benefit period combined
  • Speech Therapy No charge after deductible, 30 visit maximum per benefit period