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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.
Prestige Bronze 0 Plan Highlights |
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DEDUCTIBLE |
Individual |
$6,700 |
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Family |
$13,400 |
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COINSURANCE |
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$0 after deductible |
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OUT-OF- |
Individual |
$8,150 |
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Family |
$16,300 |
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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 |
$0 after deductible |
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Virtual Visit |
$0 after deductible |
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Specialist Visit |
$0 after deductible |
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Chiropractic |
$0 after deductible |
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Hospital Stay |
$0 after deductible |
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Emergency Room |
$0 after deductible |
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X-ray and Diagnostic Imaging |
$0 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 0 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 |
$20 |
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Tier 3 Brand Drugs |
$70 after deductible |
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Tier 4 Non-Preferred Brand Drugs |
35% after deductible |
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Tier 5 Preferred Specialty Drugs |
35% after deductible |
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Tier 6 Non-Preferred Specialty Drugs |
50% after deductible |
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