Robin Select $6,350 Plus Bronze – PPO
Network type: PPO
Coverage tier: Expanded Bronze
Primary care visit: $30 copay after deductible, 30% coinsurance after deductible
Specialist visit: $30 copay after deductible, 30% coinsurance after deductible
Urgent care visit: $30 copay after deductible, 30% coinsurance after deductible
Description
Health Care Plan Details
| Network type | PPO |
| Deductible | $6,350 per person $6,350 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $30 copay after deductible, 30% coinsurance after deductible |
| Specialist visit | $30 copay after deductible, 30% coinsurance after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay after deductible, 30% coinsurance after deductible |
| Emergency room | 30% coinsurance after deductible |
| Ambulance | 30% coinsurance after deductible |
| Hospital stay (facility) | 30% coinsurance after deductible |
| Hospital stay (physician) | 30% coinsurance after deductible |
| Outpatient procedure (facility) | 30% coinsurance after deductible |
| Outpatient procedure (physician) | 30% coinsurance after deductible |
| Physical rehabilitation | 30% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 30% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $25 copay |
| Brand | 30% coinsurance after deductible |
| Non-preferred Brand | 30% coinsurance after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 30% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 30% coinsurance after deductible |
| Blood work | 30% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 30% coinsurance after deductible |
| Psychiatric hospital stay | 30% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.healthpartners.com/content/dam/plan/sbc/hp/2024/wi-sbc-filing-only/ir672robinselect6350plusbronze.pdf |
| Drug and medication plan formulary | https://healthpartners.com/preferredrx |
| Search doctor list | https://www.healthpartners.com/robin/selectind |
