Dean Bronze Copay PCP 8000X (Free Virtual Visits) – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$8,000 per person $8,000 per person
Out-of-pocket max	$9,450 per person $18,900 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	$30 copay
Specialist visit	20% coinsurance after deductible
Preventive care visit	No data available

Urgent, Emergency Care, and Hospital Care

Urgent care	20% coinsurance after deductible
Emergency room	20% coinsurance after deductible
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	20% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	$30 copay

Maternitowny and Pregnancy

Well baby care	No data available
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$20 copay
Brand	20% coinsurance after deductible
Non-preferred Brand	20% coinsurance after deductible
Specialty	20% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$30 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://sbc.deancare.com/api/GetPdfFile/true/Dean-Bronze-Copay-PCP-8000X01_0124.PDF
Drug and medication plan formulary	https://www.deancare.com/WIDrugList-2024
Search doctor list	https://www.deancare.com/SearchDeanNetwork-2024