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Prestige Bronze Plus
The Prestige Bronze Plus plan is good for an individual who wants an affordable monthly premium and quality coverage, without dental or vision benefits. There are separate copayments and coinsurance for prescription drugs. The below chart details the benefits of this plan.
Prestige Bronze Plus Plan Highlights |
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|---|---|---|---|
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DEDUCTIBLE |
Individual |
$7,500 |
|
|
Family |
$15,000 |
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|
COINSURANCE |
|
50% |
|
|
OUT-OF- |
Individual |
$9,400 |
|
|
Family |
$18,800 |
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|
BENEFITS |
Preventive Care |
$0 |
|
|
Routine Vision Exam |
Not covered | ||
|
Annual Dental Exam |
Not covered |
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|
Personal Doctor Visit |
$50 per visit |
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|
Virtual Visit |
$0 per visit |
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|
Specialist Visit |
$100 per visit |
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|
Chiropractic |
50% after deductible |
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|
Hospital Stay |
50% after deductible |
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|
Emergency Room |
50% after deductible |
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|
X-ray and Diagnostic Imaging |
50% after deductible |
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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 Plus Pharmacy Benefit Highlights |
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|
Retail |
Preventive Drugs |
$0 |
|
Adherence Generics |
$0 |
|
|
Tier 1 Generics |
$25 |
|
|
Tier 2 Preferred Brand Drugs |
$50 after deductible |
|
|
Tier 3 Non-Preferred Brand Drugs |
$100 after deductible |
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|
Tier 4 Preferred Specialty Drugs |
$500 after deductible |
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|
Tier 5 Non-Preferred Specialty Drugs |
$500 after deductible |
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