IFP ON Bronze Plus HMO – HMO
Network type: HMO
Coverage tier: Bronze
Primary care visit: $55 copay
Specialist visit: $100 copay
Urgent care visit: $50 copay
Description
Health Care Plan Details
Network type | HMO |
Deductible | $4,725 per person $4,725 per person |
Out-of-pocket max | $9,450 per person $18,900 per family |
Metal tier | Bronze |
Visit Copay
Primary care visit | $55 copay |
Specialist visit | $100 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $50 copay |
Emergency room | 50% after deductible |
Ambulance | 50% after deductible |
Hospital stay (facility) | 50% after deductible |
Hospital stay (physician) | 50% after deductible |
Outpatient procedure (facility) | 50% after deductible |
Outpatient procedure (physician) | 50% after deductible |
Physical rehabilitation | $100 copay |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | 50% after deductible |
Pharmacy, Drugs, and Medication
Generic | $20 copay |
Brand | 50% after deductible |
Non-preferred Brand | 50% after deductible |
Specialty | 50% after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 50% after deductible |
Imaging (CT/PET/MRI) | 50% after deductible |
Blood work | 50% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 50% after deductible |
Psychiatric hospital stay | 50% after deductible |