Premera Preferred Bronze 5250 HSA (Washington)

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Company Premera Blue Cross
Plan Year 2014
State Washington
Metal Tier Bronze
Plan Type PPO
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Cost Sharing Benefits (In Network)

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.

Deductible (Individual) $5,250
Deductible (Family) $10,500
Coinsurance $0
Out of Pocket Maximum (Individual) $5,250
Out of Pocket Maximum (Family) $10,500

Doctors Visits

Primary Care Visit $0
Specialist Visit $0
In Patient Hospital Services $0
Emergency Room Services $0

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $0
Laboratory Outpatient and Professional Services $0
X-ray and Diagnostic Imaging $0


Mental / Behavioral Health $0
Rehabilitative Speech Therapy $0
Rehabilitative Occupational & Physical Therapy $0
Outpatient Facility $0
Outpatient Surgery $0

Prescription Drugs

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.

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