Bronze 60 HMO

Health Insurance Plan Details (2024 Plan)

by Aetna CVS Health

Monthly Premium

HMO
$ubsidy
Bronze
Deductible
$6,300 /yr
Max Out-of-Pocket
$9,100 /yr

Details

Deductible (per individual) $6,300 /yr
Deductible (per family) $12,600 /yr
Max Out-of-Pocket (per individual) $9,100 /yr
Max Out-of-Pocket (per family) $18,200 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type HMO
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $60 Copay
Specialist Visit $95 Copay
Emergency Room 40.00% Coinsurance after deductible
Inpatient Facility 40.00% Coinsurance after deductible
Inpatient Physician 40.00% Coinsurance after deductible
Drug Costs
Generic Drugs $17 Copay after deductible
Preferred Brand Drugs 40.00% Coinsurance after deductible
Non-preferred Brand Drugs 40.00% Coinsurance after deductible
Specialty Drugs 40.00% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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