Individual Plan Details

Prestige Silver 20 HDHP

This plan offers a deductible and coinsurance midway between the Bronze and Gold HDHP plans. This is the perfect plan for you if you want a reasonable deductible at a lower premium than a Gold Level plan. Once your deductible has been met, Network Health will pay 20 percent coinsurance on additional in-network medical care you receive. This plan is HSA (Health Savings Account) qualified if a cost-sharing reduction subsidy is not applied. The below chart details the benefits of this plan.

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Prestige Silver 20 HDHP Plan Highlights

DEDUCTIBLE

Individual

$3,500

Family

$7,000

COINSURANCE

 

20%

OUT-OF-
POCKET LIMIT

Individual

$6,750

Family

$13,500

BENEFITS

Preventive Care

$0

Primary Care Doctor Visit

20% after deductible

Virtual 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 Silver 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.