MDwise - MDwise Marketplace Bronze Plus with Adult Vision

Indiana, 2017

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $5,400

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) $5,400
Deductible (Family) $10,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $750 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $600 Copay after deductible
Laboratory Outpatient and Professional Services $375 Copay after deductible
X-Ray and Diagnostic Imaging $375 Copay after deductible

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Not available
Heart Disease Not 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 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy $120 Copay after deductible
Rehabilitative Occupational & Physical Therapy $120 Copay after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Indiana

Plan MDwise Marketplace Bronze Plus Deductible $5,400 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Plus with Adult Vision Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,000
Plan MDwise Marketplace Gold Plus with Adult Vision Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan MDwise Marketplace Silver Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,000
Plan MDwise Marketplace Bronze Basic Deductible $6,800 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Basic Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Coinsurance Deductible $3,600 Coinsurance Not applicable Out of Pocket $6,400
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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) $5,400
Deductible (Family) $10,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $750 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $600 Copay after deductible
Laboratory Outpatient and Professional Services $375 Copay after deductible
X-Ray and Diagnostic Imaging $375 Copay after deductible

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Not available
Heart Disease Not 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 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy $120 Copay after deductible
Rehabilitative Occupational & Physical Therapy $120 Copay after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Indiana

Plan MDwise Marketplace Bronze Plus Deductible $5,400 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Plus with Adult Vision Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,000
Plan MDwise Marketplace Gold Plus with Adult Vision Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan MDwise Marketplace Silver Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,000
Plan MDwise Marketplace Bronze Basic Deductible $6,800 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Basic Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan MDwise Marketplace Silver Coinsurance Deductible $3,600 Coinsurance Not applicable Out of Pocket $6,400