Group Health - Core BronzeCarrier Logo Remove from Comparison Apply Multi-State Plan Blue Cross Bronze 5250 HSACarrier Logo Remove from Comparison Apply Multi-State Plan Blue Cross Bronze 6350Carrier Logo Remove from Comparison Apply Quick Glance Estimated Monthly Premium $742.41 $785.69 $824.80 Your Estimated Cost $525.38 $568.66 $607.77 Your Health Care Provider/Hospital Not Applicable Not Applicable Not Applicable Quality Summary Quality Improvement Strategy Quality Improvement Strategy Quality Improvement Strategy Pediatric Quality Quality Improvement Strategy Quality Improvement Strategy Quality Improvement Strategy Enrollee Satisfaction/Consumer Rating System Quality Improvement Strategy Quality Improvement Strategy Quality Improvement Strategy Plan Type Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Preferred Provider Organization (PPO) Plan Metal Level BRONZE BRONZE BRONZE Out of Pocket Costs Annual Deductible $5,000 Individual / $10,000 Family $5,250 Individual / $10,500 Family $6,350 Individual / $12,700 Family Annual Out of Pocket Maximum $6,350 Individual / $12,700 Family $5,250 Individual / $10,500 Family $6,350 Individual / $12,700 Family Office Visit for Primary Care $40 Copay after deductible; 0% Coinsurance $0 Copay; 0% Coinsurance after deductible $20 Copay; 0% Coinsurance Office Visit for Specialist $60 Copay after deductible; 0% Coinsurance $0 Copay; 0% Coinsurance after deductible $50 Copay; 0% Coinsurance Prescription Drug Deductible Included in Annual Deductible Included in Annual Deductible Included in Annual Deductible Emergency Room $200 Copay after deductible; 40% Coinsurance $0 Copay; 0% Coinsurance after deductible $250 Copay before deductible; 0% Coinsurance after deductible Out Patient Lab/X-ray $0 Copay; 40% Coinsurance after deductible $0 Copay; 0% Coinsurance after deductible $0 Copay; 0% Coinsurance after deductible Out Patient Surgery $0 Copay; 40% Coinsurance after deductible $0 Copay; 0% Coinsurance after deductible $0 Copay; 0% Coinsurance after deductible Hospitalization $0 Copay per Day; 40% Coinsurance after deductible $0 Copay per Day; 0% Coinsurance after deductible $0 Copay per Day; 0% Coinsurance after deductible Lifetime Maximum Unlimited Unlimited Unlimited Health Savings Account Eligible NO YES NO See more details image See More Details
Posted on: Mon, 04 Nov 2013 17:00:09 +0000
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