Gundersen - Performance Bronze 7500 - Copay $80/$160

Illinois, 2019

  • Plan Type

    HMO

  • Metal Tier

    Expanded Bronze

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $7,500

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) $7,500
Deductible (Family) $15,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services Data Not Available

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 Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Illinois

Plan Performance Gold Maintenance - Copay $40/$90 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Gold HSA 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Performance Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver HSA 5400 Deductible $5,400 Coinsurance Not applicable Out of Pocket $5,400
Plan Performance Bronze HSA 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan Performance Silver 4000 - Copay $45/$90 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Gold HSA 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $3,000
Plan Performance Gold 2000 - Copay $30/$70 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver 7900 - Copay $80/$160 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Bronze 7900 - Copay $50/$100 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver 5000 - Copay $50/$100 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
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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) $7,500
Deductible (Family) $15,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services Data Not Available

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 Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Illinois

Plan Performance Gold Maintenance - Copay $40/$90 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Gold HSA 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Performance Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver HSA 5400 Deductible $5,400 Coinsurance Not applicable Out of Pocket $5,400
Plan Performance Bronze HSA 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan Performance Silver 4000 - Copay $45/$90 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Gold HSA 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $3,000
Plan Performance Gold 2000 - Copay $30/$70 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver 7900 - Copay $80/$160 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Bronze 7900 - Copay $50/$100 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Performance Silver 5000 - Copay $50/$100 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900