Ridgeview Distinct by Medica Bronze Copay (First 3)

Health Insurance Plan Details (2025 Plan)

by Medica Insurance Company

Monthly Premium

EPO
$ubsidy
Bronze
Deductible
$7,200 /yr
Max Out-of-Pocket
$9,200 /yr

Details

Deductible (per individual) $7,200 /yr
Deductible (per family) $14,400 /yr
Max Out-of-Pocket (per individual) $9,200 /yr
Max Out-of-Pocket (per family) $18,400 /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 EPO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit 50.00% Coinsurance after deductible
Specialist Visit 50.00% Coinsurance after deductible
Emergency Room 50.00% Coinsurance after deductible
Inpatient Facility 50.00% Coinsurance after deductible
Inpatient Physician 50.00% Coinsurance after deductible
Drug Costs
Generic Drugs $25 Copay
Preferred Brand Drugs $200 Copay
Non-preferred Brand Drugs 70.00% Coinsurance after deductible
Specialty Drugs $750 Copay

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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