US Health and Life

Balanced Bronze 2

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Specialist
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Generic Drugs
  • CoPay: $15.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Exclusions: Blood
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Urgent Care Facility
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Benefit Explanation: Also covers surrogate mother if there is a petition to adopt within 90 days of birth.
Pre and Postnatal Office Visit
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Also covers surrogate mother if there is a petition to adopt within 90 days of birth.

Vision

Routine Eye Exams For Children
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • 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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