Gundersen - Bronze HSA $4400 - 50%

Iowa, 2017

  • Plan Type

    POS

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,550

  • Deductible

    $4,400

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $4,400
Deductible (Family) $8,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 50% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Iowa

Plan Bronze $6500 - 10% Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Silver HSA $2000 - 50% Deductible $2,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Silver $2500 - 20% Deductible $2,500 Coinsurance Not applicable Out of Pocket $5,000
Plan Platinum $1000 - 0% Deductible $1,000 Coinsurance Not applicable Out of Pocket $1,000
Plan Bronze HSA $6550 - 0% Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Bronze HSA $5750 - 20% Deductible $5,750 Coinsurance Not applicable Out of Pocket $6,550
Plan Silver $2500 - 50% Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze $3750 - 50% Deductible $3,750 Coinsurance Not applicable Out of Pocket $7,150
Plan Silver HSA $4400 - 0% Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan Gold $3500 - 0% Deductible $3,500 Coinsurance Not applicable Out of Pocket $3,500
Plan Platinum $500 - 20% Deductible $500 Coinsurance Not applicable Out of Pocket $1,000
Plan Gold $1750 - 30% Deductible $1,750 Coinsurance Not applicable Out of Pocket $3,250
Plan Silver $4000 - 10% Deductible $4,000 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze $5000 - 10% Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Catastrophic $7150 - 0% Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
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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) $4,400
Deductible (Family) $8,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 50% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 50% Coinsurance after deductible
Preferred Brand Rx 50% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Iowa

Plan Bronze $6500 - 10% Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Silver HSA $2000 - 50% Deductible $2,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Silver $2500 - 20% Deductible $2,500 Coinsurance Not applicable Out of Pocket $5,000
Plan Platinum $1000 - 0% Deductible $1,000 Coinsurance Not applicable Out of Pocket $1,000
Plan Bronze HSA $6550 - 0% Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Bronze HSA $5750 - 20% Deductible $5,750 Coinsurance Not applicable Out of Pocket $6,550
Plan Silver $2500 - 50% Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze $3750 - 50% Deductible $3,750 Coinsurance Not applicable Out of Pocket $7,150
Plan Silver HSA $4400 - 0% Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan Gold $3500 - 0% Deductible $3,500 Coinsurance Not applicable Out of Pocket $3,500
Plan Platinum $500 - 20% Deductible $500 Coinsurance Not applicable Out of Pocket $1,000
Plan Gold $1750 - 30% Deductible $1,750 Coinsurance Not applicable Out of Pocket $3,250
Plan Silver $4000 - 10% Deductible $4,000 Coinsurance Not applicable Out of Pocket $6,000
Plan Bronze $5000 - 10% Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Catastrophic $7150 - 0% Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150