Individual Plan Details

Prestige Bronze 20 HDHP

This plan, as displayed here, is perfect for a person who want to pair their individual health plan with a health savings account (HSA). With Prestige Bronze 20 HDHP, once your deductible is met, Network Health will pay 20% coinsurance on additional in-network services you need. Preventive care is covered 100 percent. The below chart details the benefits of this plan.

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Prestige Bronze 20 HDHP Plan Highlights

DEDUCTIBLE

Individual

$6,000

Family

$12,000

COINSURANCE

 

20%

OUT-OF-
POCKET LIMIT

Individual

$6,750

Family

$13,500

BENEFITS

Preventive Care

$0

Primary Care Doctor Visit

20% after deductible

Specialist Visit

20% after deductible

Chiropractic

20% after deductible

Hospital Stay

20% after deductible

Emergency Room

20% after deductible

X-ray and Diagnostic Imaging

20% after deductible

Laboratory Outpatient Services

20% 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 20 HDHP 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)

20% after deductible (Tier 1)

Generics

20% after deductible (Tier 2)

Preferred Brand Drugs

20% 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.