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Wellpoint Essential ICHRA Silver 3400 HSA (+ Incentives)

WellPoint
by WellPoint
2026 health insurance plan
Monthly Premium

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SilverPOSHSA eligible
Deductible · ind / family $3,400 / $6,800
Max out-of-pocket · ind / family $8,450 / $16,900
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Estimated yearly cost

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Coverage details

Deductible · individual $3,400 /yr
Deductible · family $6,800 /yr
Max out-of-pocket · individual $8,450 /yr
Max out-of-pocket · family $16,900 /yr
Includes child dental No
Includes adult dental No

Benefit details and out-of-pocket costs

Doctor visits

Preventive care & screenings No charge
Primary care visit 10.00% Coinsurance after deductible
Specialist visit $85 Copay after deductible

Hospital & emergency

Emergency room 30.00% Coinsurance after deductible
Inpatient facility 20.00% Coinsurance after deductible
Inpatient physician 10.00% Coinsurance after deductible

Prescription drugs

Tier 1 · Generic $5 Copay
Tier 2 · Preferred brand $60 Copay
Tier 3 · Non-preferred brand $250 Copay after deductible
Tier 4 · Specialty $400 Copay after deductible

Plan documents & tools

* Figures shown are only for in-network medical costs.

** Please check with the insurance company if copay and coinsurance rates are before or after the deductible.

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