Individual Plan Details

Prestige Gold 50

This plan offers quality coverage with the lowest deductible of all our plans. It also has the lowest out-of-pocket maximum and Network Health provides 50 percent coinsurance on covered-in network services once the deductible has been met. This plan is ideal for a person who is comfortable paying a higher monthly premium and receiving lower medical bills throughout the year. The below chart details the benefits of this plan.

Get a Personalized Quote

 

Prestige Gold 50 Plan Highlights

DEDUCTIBLE

Individual

$1,000

Family

$2,000

COINSURANCE

 

50%

OUT-OF-
POCKET LIMIT

Individual

$4,300

Family

$8,600

BENEFITS

Preventive Care

$0

Primary Care Doctor Visit

50% after deductible

Specialist Visit

50% after deductible

Chiropractic

50% after deductible

Hospital Stay

50% after deductible

Emergency Room

50% after deductible

X-ray and Diagnostic Imaging

50% after deductible

Laboratory Outpatient Services

50% 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 Gold 50 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

$15
(Tier 2)

Preferred Brand Drugs

$50
(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.