Bronze HMO 8000/0/50

Apply Off Pennie

Apply On Pennie

Plan overview

Plan availability
County of residence	Available in all 21 counties
Exchange	Off Pennie

Covered services

Plan details	You pay
Deductible (individual / family)	$8,000 / $16,000
Out-of-pocket max (individual / family)	$8,550 / $17,100
Coinsurance	None

Doctor visits	You pay
Primary care office visit	$50 copay
Specialist office visit	$85 copay

Emergencies	You pay
Emergency room	Paid in full after deductible
Urgent care	Paid in full after deductible

Tests and lab work	You pay
Diagnostic lab services	$25 copay (deductible waived) for independent clinical labs / Paid in full after deductible for facility owned labs
Outpatient diagnostic test (X-ray)	Paid in full after deductible
Outpatient high tech imaging	Paid in full after deductible

Hospital services	You pay
Outpatient surgery service	Paid in full after deductible
Inpatient hospital admission	Paid in full after deductible

Prescriptions	You pay
Retail Rx	Paid in full after deductible
Home delivery Rx	Paid in full after deductible

Cost Share amounts listed in the chart are for service performed at in-network providers.

Sections

Plan availability

Tests and lab work

Hospital services

Plan documents

Highlight sheet

Summary of benefits and coverage

Subscriber agreement

Need more information?

Understanding health insurance

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