HA Bronze Suitcase – POS
Network type: POS
Coverage tier: Expanded Bronze
Primary care visit: $45 copay
Specialist visit: $100 copay
Urgent care visit: No charge after deductible
Description
Health Care Plan Details
| Network type | POS |
| Deductible | $9,250 per person $9,250 per person |
| Out-of-pocket max | $9,250 per person $18,500 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $45 copay |
| Specialist visit | $100 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | No charge after deductible |
| Emergency room | No charge after deductible |
| Ambulance | No charge after deductible |
| Hospital stay (facility) | No charge after deductible |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | No charge after deductible |
| Outpatient procedure (physician) | No charge after deductible |
| Physical rehabilitation | $45 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
| Generic | $30 copay |
| Brand | $210 copay |
| Non-preferred Brand | $1,600 copay |
| Specialty | $5,000 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge after deductible |
| Imaging (CT/PET/MRI) | No charge after deductible |
| Blood work | No charge after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $45 copay |
| Psychiatric hospital stay | No charge after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://secure.healthadvantage-hmo.com/members/ViewSbc.aspx?id=60027&year=2024 |
| Drug and medication plan formulary | http://www.healthadvantage-hmo.com/ha-formulary-2024 |
| Search doctor list | https://secure.healthadvantage-hmo.com/providerdirectory/trueblueppo.aspx |
