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Medica - Altru Prime by Medica Bronze Copay
North Dakota, 2019
Plan Type
HMO
Metal Tier
Bronze
Out of Pocket Maximum
$7,900
Deductible
$6,850
Emergency Room Care: 50% Coinsurance after deductible
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) | $6,850 |
|---|---|
| Deductible (Family) | $13,700 |
| 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 | 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 | Available |
| Lower Back Pain | Available |
| Pain Management | 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 | 70% Coinsurance after deductible |
| Specialty Drugs |
Other Plans in North Dakota
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Altru Prime by Medica Gold Copay | Deductible $750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Medica Individual Choice Bronze HSA Plus | Deductible $3,100 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Medica Individual Choice Bronze HSA | Deductible $6,200 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Altru Prime by Medica Bronze H S A | Deductible $6,200 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Altru Prime by Medica Bronze H S A Plus | Deductible $3,100 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Medica Individual Choice Gold Copay | Deductible $750 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Medica Individual Choice Bronze Copay | Deductible $6,850 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Medica Individual Choice Silver Copay | Deductible $3,700 | Coinsurance Not applicable | Out of Pocket $7,600 |
| Plan Altru Prime by Medica Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Medica Individual Choice Catastophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Altru Prime by Medica Silver Copay | Deductible $3,700 | Coinsurance Not applicable | Out of Pocket $7,600 |