Navigator Bronze 7000 – PPO

Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $35 copay
Specialist visit: $50 copay after deductible
Urgent care visit: $35 copay

Description

Health Care Plan Details

Network type PPO
Deductible $7,000 per person $7,000 per person
Out-of-pocket max $8,700 per person $17,400 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit $35 copay
Specialist visit $50 copay after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $35 copay
Emergency room 40% after deductible
Ambulance 40% after deductible
Hospital stay (facility) 40% after deductible
Hospital stay (physician) 40% after deductible
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 40% after deductible
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 $35 copay
Psychiatric hospital stay 40% after deductible

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/1wnKusUDAtpqzFkyXzvr6UQY.pdf
Drug and medication plan formulary https://pacificsource.com/find-a-drug