- Banned
- #1
SelectBlue Plus $2750 HDHP BRONZEAdd to Cart Add to Quote
Your Cost:
$568.72/mo
Plan Details
View Summary of Benefits & CoverageView Options at a Glance
Metal Tier
BRONZE
Calendar Year Deductible
Annual Deductible :
$2,750 Individual / $5,500 Family
Coinsurance
Coinsurance for Most Covered Services :
40% after deductible
Physician Office Services
Primary Care Physician :
40% Coinsurance after deductible
Specialist :
40% Coinsurance after deductible
Prescription Drug Coverage
Rx Coverage :
40% Coinsurance after deductible
Maximum Out of Pocket
Maximum Out of Pocket :
$5,500 Individual / $11,000 Family
Mental Illness/Substance Abuse
Inpatient Treatment :
40% Coinsurance after deductible
Outpatient Treatment :
40% Coinsurance after deductible
Maternity Benefits
Coinsurance for Maternity Benefits :
40% after deductible
Emergency Services
Ambulance Service :
40% Coinsurance after deductible
Urgent Care Facility :
40% Coinsurance after deductible
Emergency Room Services :
40% Coinsurance after deductible
Preventive Care Services
Preventive Care Services :
No Charge
Pediatric Vision
Routine Eye Exam for Children :
40% Coinsurance after deductible
Eye Glass for Children :
50% Coinsurance after deductible
Pediatric Dental
Basic Dental Care for Children :
40% Coinsurance after deductible
Orthodontia for Children :
70% Coinsurance after deductible
Major Dental Care for Children :
40% Coinsurance after deductible
Dental Check-up for Children :
40% Coinsurance after deductible
$2750 Bonze
Your Cost:
$568.72/mo
Plan Details
View Summary of Benefits & CoverageView Options at a Glance
Metal Tier
BRONZE
Calendar Year Deductible
Annual Deductible :
$2,750 Individual / $5,500 Family
Coinsurance
Coinsurance for Most Covered Services :
40% after deductible
Physician Office Services
Primary Care Physician :
40% Coinsurance after deductible
Specialist :
40% Coinsurance after deductible
Prescription Drug Coverage
Rx Coverage :
40% Coinsurance after deductible
Maximum Out of Pocket
Maximum Out of Pocket :
$5,500 Individual / $11,000 Family
Mental Illness/Substance Abuse
Inpatient Treatment :
40% Coinsurance after deductible
Outpatient Treatment :
40% Coinsurance after deductible
Maternity Benefits
Coinsurance for Maternity Benefits :
40% after deductible
Emergency Services
Ambulance Service :
40% Coinsurance after deductible
Urgent Care Facility :
40% Coinsurance after deductible
Emergency Room Services :
40% Coinsurance after deductible
Preventive Care Services
Preventive Care Services :
No Charge
Pediatric Vision
Routine Eye Exam for Children :
40% Coinsurance after deductible
Eye Glass for Children :
50% Coinsurance after deductible
Pediatric Dental
Basic Dental Care for Children :
40% Coinsurance after deductible
Orthodontia for Children :
70% Coinsurance after deductible
Major Dental Care for Children :
40% Coinsurance after deductible
Dental Check-up for Children :
40% Coinsurance after deductible
$2750 Bonze
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