LINK BRONZE – POS

Network type: POS
Coverage tier: Expanded Bronze
Primary care visit: No charge
Specialist visit: No charge after deductible
Urgent care visit: $110 copay

Description

Health Care Plan Details

Network type POS
Deductible $8,900 per person $8,900 per person
Out-of-pocket max $8,900 per person $17,800 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit No charge
Specialist visit No charge after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $110 copay
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 No charge after deductible

Maternitowny and Pregnancy

Labor, delivery, hospital stay No charge after deductible

Pharmacy, Drugs, and Medication

Generic No charge after deductible
Brand No charge after deductible
Non-preferred Brand No charge after deductible
Specialty No charge after deductible

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 No charge
Psychiatric hospital stay No charge after deductible

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/4dgbTxrE6qQyki9TNfz9M5CL.pdf
Drug and medication plan formulary https://mountainhealth.coop/pharmacy/