Individual and Family Plans

Prestige Bronze 0

This is a new plan for 2019. The Prestige Bronze 0 plan is good for an individual who wants a low monthly premium and quality coverage. You will pay $0 for most medical services once your deductible is met. There are separate copayments and coinsurance for prescription drugs. The below chart details the benefits of this plan.

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Prestige Bronze 0 Plan Highlights

DEDUCTIBLE

Individual

$6,500

Family

$13,000

COINSURANCE

 

No charge after deductible

OUT-OF-
POCKET LIMIT

Individual

$7,900

Family

$15,800

BENEFITS

Preventive Care

$0

Primary Care Doctor Visit

$0 after deductible

Specialist Visit

$0 after deductible

Chiropractic

$0 after deductible

Hospital Stay

$0 after deductible

Emergency Room

$0 after deductible

X-ray and Diagnostic Imaging

$0 after deductible

Laboratory Outpatient Services

$0 after deductible

 

Prescription Drug Coverage 

All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.

Prestige Bronze 0 Pharmacy Benefit Highlights

Retail
30-Day
supply
Cost per
prescription
or refill

Preventive Drugs

$0

Adherence Generics (limited only to categories of select antidiabetics, statins and RAS antagonists)

$2 (Tier 1)

Generics

$20 (Tier 2)

Preferred Brand Drugs

$70 after deductible (Tier 3)

Non-Preferred Brand Drugs

35% after deductible (Tier 4)

Preferred Specialty Drugs

35% after deductible (Tier 5)

Non-Preferred Specialty Drugs

50% after deductible (Tier 6)


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.