US Health and Life

No Deductible Bronze

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Medical Deductible	Individual: $0.00 Family: $0 Per Person: $0
Prescription Drug Deductible	Individual: $5,000.00 Family: $10,000 Per Person: $5,000
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,700.00 Family: $17,400 Per Person: $8,700

Office Visit

Primary Doctor	CoPay: $50.00 CoInsurance: Not Applicable Covered: Covered
Specialist	CoPay: $100.00 CoInsurance: Not Applicable Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: $150.00 CoInsurance: Not Applicable Covered: Covered
Non Preferred Brand Drugs	CoPay: $250.00 CoInsurance: Not Applicable Covered: Covered
Generic Drugs	CoPay: $30.00 CoInsurance: Not Applicable Covered: Covered
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

Inpatient Coverage

Hospital Services	CoPay: $2000.00 Copay per Day CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Maximum 60 days per Benefit Period for Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis). Limit is combined both In and Out of Network.
Inpatient Services	CoPay: No Charge CoInsurance: Not Applicable Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: $1,000.00 CoInsurance: Not Applicable Covered: Covered
Urgent Care Facility	CoPay: Not Applicable CoInsurance: 50.00% Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: $2,000.00 CoInsurance: Not Applicable Covered: Covered
Pre and Postnatal Office Visit	CoPay: $50.00 CoInsurance: Not Applicable Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: $50.00
CoInsurance: Not Applicable
Covered: Covered

Major Dental Care

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: Not Applicable Covered: Not Covered
Routine Dental Checkups for Adults	Covered: Not Covered

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