Dean Bronze Copay Plus 9400X (Free Virtual Visits)

Health Insurance Plan Details (2024 Plan)

Monthly Premium

HMO
$ubsidy
Bronze
Deductible
$9,400 /yr
Max Out-of-Pocket
$9,400 /yr

Details

Deductible (per individual) $9,400 /yr
Deductible (per family) $18,800 /yr
Max Out-of-Pocket (per individual) $9,400 /yr
Max Out-of-Pocket (per family) $18,800 /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 $40 Copay
Specialist Visit $80 Copay
Emergency Room $500 Copay with deductible
Inpatient Facility No Charge after Deductible
Inpatient Physician No Charge after Deductible
Drug Costs
Generic Drugs $25 Copay
Preferred Brand Drugs No Charge after Deductible
Non-preferred Brand Drugs No Charge after Deductible
Specialty Drugs No Charge after Deductible

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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