Network Health 2024 Medicare Advantage PPO plans are rated 5 out of 5 stars by Medicare. Learn more.

Individual and Family Plans

Signature Prestige Bronze Copay + Dental + Vision

Our best selling plan, it is designed for individuals looking for low monthly premiums and quality coverage. Signature Prestige Bronze Copay provides preventive services for $0. In addition, you get a $0 annual vision exam and two dental exams for each covered member. This plan also features copayments without deductibles.

Get a Personalized Quote

 

Signature Prestige Bronze Copay Plan Highlights

DEDUCTIBLE

Individual

$0

Family

$0

COINSURANCE

 

0%

OUT-OF-
POCKET LIMIT

Individual

$9,100

Family

$18,200

BENEFITS

Preventive Care

$0

Routine Vision Exam

$0

Annual Dental Exam

$0

Personal Doctor Visit

$55 per visit

Virtual Visit

$0 per visit

Specialist Visit

$150 per visit 

Chiropractic

$75 per visit

Hospital Stay

$1,500 per day for days 1 and 2

Emergency Room

$2,000 per visit

X-ray and Diagnostic Imaging

$150 per visit

 

Prescription Drug Coverage

All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.

Signature Prestige Bronze Copay Pharmacy Benefit Highlights

Retail
30-Day
supply
Cost per

prescription
or refill

Preventive Drugs

$0

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

$0

Tier 1 Generics

$30

Tier 2 Preferred Brand Drugs

$160

Tier 3 Non-Preferred Brand Drugs

50% coinsurance

Tier 4 Preferred Specialty Drugs

40% coinsurance

Tier 5 Non-Preferred Specialty Drugs

50% coinsurance


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.

COVID-19 Information for Network Health Members

Learn more about the recent Change Healthcare breach.