LifeWise Cascade Bronze – EPO
Network type: EPO
Coverage tier: Expanded Bronze
Primary care visit: first 2 visit(s) $1 then $50 copay
Specialist visit: $100 copay after deductible
Urgent care visit: $100 copay
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | $6,000 per person $6,000 per person |
| Out-of-pocket max | $9,200 per person $18,400 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | first 2 visit(s) $1 then $50 copay |
| Specialist visit | $100 copay after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $100 copay |
| Emergency room | 40% after deductible |
| Ambulance | 40% after deductible |
| Hospital stay (facility) | 40% after deductible |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | 40% after deductible |
| Outpatient procedure (physician) | 40% after deductible |
| Physical rehabilitation | 40% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 40% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $32 copay |
| Brand | 40% after deductible |
| Non-preferred Brand | 40% after deductible |
| Specialty | 40% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 40% after deductible |
| Imaging (CT/PET/MRI) | 40% after deductible |
| Blood work | 40% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | first 2 visit(s) $1 then $50 copay |
| Psychiatric hospital stay | 40% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/bzJwn74QBbrnjRt6NMcaBD7K.pdf |
| Drug and medication plan formulary | https://www.lifewisewa.com/documents/052167_2024.pdf |
