Gundersen - Performance Bronze 7900 - Copay $50/$100

Illinois, 2019

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $7,900

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) $7,900
Deductible (Family) $15,800
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 0% Coinsurance after deductible
Inpatient Physician 0% Coinsurance after deductible
Emergency Room Services 0% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 0% Coinsurance after deductible
Laboratory Outpatient and Professional Services 0% Coinsurance after deductible
X-Ray and Diagnostic Imaging 0% 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 0% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 0% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 0% Coinsurance after deductible
Outpatient Facility 0% Coinsurance after deductible
Outpatient Surgery 0% Coinsurance after deductible

Prescription Drugs

Generic Rx 0% Coinsurance after deductible
Preferred Brand Rx 0% Coinsurance after deductible
Non Preferred Brand Rx 0% Coinsurance after deductible
Specialty Drugs 0% Coinsurance after deductible

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 7500 - Copay $80/$160 Deductible $7,500 Coinsurance Not applicable Out of Pocket $7,900
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 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) $7,900
Deductible (Family) $15,800
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 0% Coinsurance after deductible
Inpatient Physician 0% Coinsurance after deductible
Emergency Room Services 0% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 0% Coinsurance after deductible
Laboratory Outpatient and Professional Services 0% Coinsurance after deductible
X-Ray and Diagnostic Imaging 0% 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 0% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 0% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 0% Coinsurance after deductible
Outpatient Facility 0% Coinsurance after deductible
Outpatient Surgery 0% Coinsurance after deductible

Prescription Drugs

Generic Rx 0% Coinsurance after deductible
Preferred Brand Rx 0% Coinsurance after deductible
Non Preferred Brand Rx 0% Coinsurance after deductible
Specialty Drugs 0% Coinsurance after deductible

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 7500 - Copay $80/$160 Deductible $7,500 Coinsurance Not applicable Out of Pocket $7,900
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 Silver 5000 - Copay $50/$100 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900