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Individual and Family Plans

Prestige Bronze 0 + Dental + Vision

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. In addition, you get a $0 annual vision exam and dental exam for each covered member. 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

$8,550

Family

$17,100

COINSURANCE

 

$0 after deductible

OUT-OF-
POCKET LIMIT

Individual

$8,550

Family

$17,100

BENEFITS

Preventive Care

$0

Routine Vision Exam

$0

Annual Dental Exam

$0

Personal Doctor Visit

$0 after deductible

Virtual 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

 

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

Tier 1 Adherence Generics (limited only to categories of select antidiabetics, statins and RAS antagonists)

0% after deductible

Tier 2 Generics

0% after deductible

Tier 3 Preferred Brand Drugs

0% after deductible

Tier 4 Non-Preferred Brand Drugs

0% after deductible

Tier 5 Preferred Specialty Drugs

0% after deductible

Tier 6 Non-Preferred Specialty Drugs

0% after deductible


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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.