Medica Insure Bronze Standard – EPO

Network type: EPO
Coverage tier: Bronze
Primary care visit: 5% coinsurance after deductible
Specialist visit: 5% coinsurance after deductible
Urgent care visit: 5% coinsurance after deductible

SKU: 93078IA0060059 Categories: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Description

Health Care Plan Details

Network type EPO
Deductible $9,100 per person $9,100 per person
Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Bronze

Visit Copay

Primary care visit 5% coinsurance after deductible
Specialist visit 5% coinsurance after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care 5% coinsurance after deductible
Emergency room 5% coinsurance after deductible
Ambulance 5% coinsurance after deductible
Hospital stay (facility) 5% coinsurance after deductible
Hospital stay (physician) 5% coinsurance after deductible
Outpatient procedure (facility) 5% coinsurance after deductible
Outpatient procedure (physician) 5% coinsurance after deductible
Physical rehabilitation 5% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 5% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic 5% coinsurance after deductible
Brand 5% coinsurance after deductible
Non-preferred Brand 5% coinsurance after deductible
Specialty 5% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays 5% coinsurance after deductible
Imaging (CT/PET/MRI) 5% coinsurance after deductible
Blood work 5% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 5% coinsurance after deductible
Psychiatric hospital stay 5% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2024-IFBIBSTIA&uid=FFM.pdf
Drug and medication plan formulary https://www.Medica.com/IADrugList-2024
Search doctor list https://www.Medica.com/SearchInsureNetwork-2024