Bronze Select, Expanded Bronze, NS, INN, Univera EPO Local, Dep29, Adult Dental, Adult Vision, Preventive Rx, Acupuncture

Health Insurance Plan Details (2024 Plan)

by Excellus Health Plan, Inc.

Monthly Premium

EPO
$ubsidy
HSA
Bronze
Deductible
$5,500 /yr
Max Out-of-Pocket
$7,500 /yr

Details

Deductible (per individual) $5,500 /yr
Deductible (per family) $11,000 /yr
Max Out-of-Pocket (per individual) $7,500 /yr
Max Out-of-Pocket (per family) $15,000 /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? Yes
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 $10 Copay after deductible
Preferred Brand Drugs 40.00% Coinsurance after deductible
Non-preferred Brand Drugs 50.00% Coinsurance after deductible
Specialty Drugs Not Applicable

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


Request a phone call from an agent

Advertisement

Health Insurance Plans

Obamacare Plans

Off-Exchange Plans

Sign Up Help
Quote & Compare

 

 

Get advice from Licensed Insurance Agents


Looking for Other Options?

Short Term Health Insurance Plans

  • Top Insurance Carriers
  • No Enrollment Period Restrictions
  • Choose Your Coverage Level
  • Emergency & Hospital Coverage
Health Plan Radar
Health Plan Radar
Partner

Call for a free quote & benefits review

Find the right short term coverage for your needs.