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Signature Prestige Bronze Copay + Dental + Vision + Fitness
This plan is designed for individuals looking for low monthly premiums and quality coverage. Prestige Signature Bronze Essential provides preventive services for $0. In addition, you get a $0 annual vision exam and dental exam for each covered member. This plan also features copayments without deductibles.
Signature Prestige Bronze Copay Plan Highlights |
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DEDUCTIBLE |
Individual |
$0 |
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Family |
$0 |
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COINSURANCE |
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$0 |
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OUT-OF- |
Individual |
$8,700 |
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Family |
$17,400 |
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BENEFITS |
Preventive Care |
$0 |
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Routine Vision Exam |
$0 |
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Annual Dental Exam |
$0 |
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Personal Doctor Visit |
$55 per visit |
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Virtual Visit |
$0 per visit |
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Specialist Visit |
$150 per visit |
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Chiropractic |
$75 per visit |
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Hospital Stay |
$1,500 per day for days 1 and 2; Skilled nursing facility - $1,500 per day |
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Emergency Room |
$1,500 per visit |
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X-ray and Diagnostic Imaging |
$150 per visit |
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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.
Signature Prestige Bronze Copay Pharmacy Benefit Highlights |
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Retail |
Preventive Drugs |
$0 |
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Tier 1 Adherence Generics (limited only to categories of select antidiabetics, statins and RAS antagonists) |
$0 |
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Tier 2 Generics |
$30 |
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Tier 3 Preferred Brand Drugs |
$160 |
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Tier 4 Non-Preferred Brand Drugs |
50% after deductible |
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Tier 5 Preferred Specialty Drugs |
40% after deductible |
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Tier 6 Non-Preferred Specialty Drugs |
50% after deductible |
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