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Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits
This plan is designed for individuals looking for low monthly premiums and quality coverage. Prestige 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 includes a free fitness benefit. The below chart details the benefits of this plan.
Prestige Bronze Essential Plan Highlights |
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DEDUCTIBLE |
Individual |
$7,200 |
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Family |
$14,400 |
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COINSURANCE |
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50% |
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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 for first three visits, then $40 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 |
$500 after deductible per visit |
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X-ray and Diagnostic Imaging |
$60 after deductible 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.
Prestige Bronze Essential 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 |
$80 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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