Bronze 1826 ($0 Medical Deductible, $0 Primary Care Copay- Visits 1 & 2, Specialist & Urgent Care Copay, Open Access) – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: No charge
Specialist visit: $50 copay
Urgent care visit: $80 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | Success
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| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $80 copay |
| Emergency room | $1,250 copay |
| Ambulance | $1,250 copay |
| Hospital stay (facility) | $3000 copay per Day |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $1,000 copay |
| Outpatient procedure (physician) | $300 copay |
| Physical rehabilitation | $100 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $3,000 copay |
Pharmacy, Drugs, and Medication
| Generic | $75 copay |
| Brand | $200 copay |
| Non-preferred Brand | 100% coinsurance after deductible |
| Specialty | 100% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $110 copay |
| Imaging (CT/PET/MRI) | $300 copay |
| Blood work | $75 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $100 copay |
| Psychiatric hospital stay | $3000 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://hf.org/2024_sbc_1826.pdf |
| Drug and medication plan formulary | https://hf.org/MP_formulary_2024 |
| Search doctor list | https://hf.org/MP_directory_2024 |
