Premera Multi-State Plan Blue Cross Bronze 5250 HSA WA

Plan Information
Company Premera Blue Cross
State WA
Metal Tier Bronze
Plan Type PPO

Cost Sharing Benefits

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $5,250 Data Not Available
Deductible (Family) $10,500 Data Not Available
Coinsurance $0 Data Not Available
Out of Pocket Maximum (Individual) $5,250 Data Not Available
Out of Pocket Maximum (Family) $10,500 Data Not Available
Services In Network Out of Network
Primary Care Visit $0 Data Not Available
Specialist Visit $0 Data Not Available
In Patient Hospital Services $0 Data Not Available
Emergency Room Services $0 $0
Mental / Behavioral Health $0 Data Not Available
Imaging (CT/PET Scans, MRIs) $0 Data Not Available
Rehabilitative Speech Therapy $0 Data Not Available
Rehabilitative Occupational & Physical Therapy $0 Data Not Available
Preventative Care $0 Data Not Available
Laboratory Outpatient and Professional Services $0 Data Not Available
X-ray and Diagnostic Imaging $0 Data Not Available
Outpatient Facility $0 Data Not Available
Outpatient Surgery $0 Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $0
Preferred Brand Rx $0
Non Preferred Brand Rx $0
Specialty Drugs 0

Other Plans

Other plans that are available in the state.

Plan Name
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