Bronze Essential 8500 With 4 Copay No Deductible Office Visits Individual and Family Network – EPO

Description

Health Care Plan Details

Network type	EPO
Deductible	Success Your progress has been saved. We have sent an email to with a link to continue your application ×
Out-of-pocket max	$9,100 per person $18,200 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	$60 copay, 10% coinsurance after deductible
Specialist visit	$60 copay, 10% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$60 copay, 10% coinsurance after deductible
Emergency room	10% coinsurance after deductible
Ambulance	10% coinsurance after deductible
Hospital stay (facility)	10% coinsurance after deductible
Hospital stay (physician)	10% coinsurance after deductible
Outpatient procedure (facility)	10% coinsurance after deductible
Outpatient procedure (physician)	10% coinsurance after deductible
Physical rehabilitation	10% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	10% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$15 copay
Brand	20% coinsurance after deductible
Non-preferred Brand	50% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	10% coinsurance after deductible
Imaging (CT/PET/MRI)	10% coinsurance after deductible
Blood work	10% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	10% coinsurance after deductible
Psychiatric hospital stay	10% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://regence.com/go/2024/SBC/OR/BronzeEssential8500With4CopayNoDeductibleOfficeVisitsIFNEx
Drug and medication plan formulary	https://regence.com/go/2024/OR/4tier
Search doctor list	https://regence.com/go/OR/IFN