Bronze 1 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay

Health Insurance Plan Details (2025 Plan)

Monthly Premium

HMO
$ubsidy
Bronze
Deductible
$8,195 /yr
Max Out-of-Pocket
$9,195 /yr

Details

Deductible (per individual) $8,195 /yr
Deductible (per family) $16,390 /yr
Max Out-of-Pocket (per individual) $9,195 /yr
Max Out-of-Pocket (per family) $18,390 /yr
Drug Deductible (per individual) Included in Medical
Drug Deductible (per family) Included in Medical
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type HMO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $10 Copay
Specialist Visit $125 Copay
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Drug Costs
Generic Drugs $25 Copay
Preferred Brand Drugs $125 Copay
Non-preferred Brand Drugs $175 Copay
Specialty Drugs $500 Copay

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List drug list

* 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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