Jefferson Health Plans + $0 Deductible + Bronze + HMO + On Exchange – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $55 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | Success
Your progress has been saved. We have sent an email to with a link to continue your application × |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Expanded 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 | $100 copay |
| Emergency room | $1,200 copay |
| Ambulance | $1,000 copay |
| Hospital stay (facility) | first 5 day(s) $1,800 per day then $0 copay |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $990 copay |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $150 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | first 5 day(s) $1,800 per day then $0 copay |
Pharmacy, Drugs, and Medication
| Generic | $35 copay |
| Brand | $200 copay |
| Non-preferred Brand | $250 copay after deductible |
| Specialty | 50% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $250 copay |
| Imaging (CT/PET/MRI) | $250 per procedure copay |
| Blood work | $350 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $100 copay |
| Psychiatric hospital stay | first 5 day(s) $1,800 per day then $0 copay |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/RcgDQ7pnBGFauuZL4c6hYwfz.pdf |
| Drug and medication plan formulary | https://www.jeffersonhealthplans.com/ |
