Prestige Bronze 20 HDHP + Dental + Vision – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$6,500 per person $6,500 per person
Out-of-pocket max	$7,500 per person $15,000 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	20% coinsurance after deductible
Specialist visit	20% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	20% coinsurance after deductible
Emergency room	An urgent care center can be a convenient option if you have a non-life-threatening injury and your doctor is not available.
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	20% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	20% coinsurance after deductible
Brand	20% coinsurance after deductible
Non-preferred Brand	50% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	20% coinsurance after deductible
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://networkhealth.com/__assets/pdf/individual-benefits-2024/bronze20hdhp.pdf
Drug and medication plan formulary	https://www.networkhealth.com/__assets/pdf/pharmacy-drug-lists/2024individualdruglist5tier.pdf
Search doctor list	https://www.networkhealth.com/find-a-doctor-prestige