Dean Focus Network Bronze Standard 9100X (Free Virtual Visits) – EPO

Description

Health Care Plan Details

Network type	EPO
Deductible	$9,100 per person $9,100 per person
Out-of-pocket max	$9,450 per person $18,900 per family
Metal tier	Bronze

Visit Copay

Primary care visit	5% coinsurance after deductible
Specialist visit	5% coinsurance after deductible
Preventive care visit	No data available

Urgent, Emergency Care, and Hospital Care

Urgent care	5% coinsurance after deductible
Emergency room	5% coinsurance after deductible
Ambulance	5% coinsurance after deductible
Hospital stay (facility)	5% coinsurance after deductible
Hospital stay (physician)	5% coinsurance after deductible
Outpatient procedure (facility)	5% coinsurance after deductible
Outpatient procedure (physician)	5% coinsurance after deductible
Physical rehabilitation	5% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No data available
Labor, delivery, hospital stay	5% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	5% coinsurance after deductible
Brand	5% coinsurance after deductible
Non-preferred Brand	5% coinsurance after deductible
Specialty	5% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	5% coinsurance after deductible
Imaging (CT/PET/MRI)	5% coinsurance after deductible
Blood work	5% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	5% coinsurance after deductible
Psychiatric hospital stay	5% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://sbc.deancare.com/api/GetPdfFile/true/Dean-Focus-Network-Bronze-Standard-9100X01_0124.PDF
Drug and medication plan formulary	https://www.deancare.com/WIDrugList-2024
Search doctor list	https://www.deancare.com/SearchFocusNetwork-2024