SummaCare Bronze 5000 HSA with SCConnect Network
| Plan Type: | PPO |
| Plan Tier: | Bronze |
| Medical Deductible - Individual: | $5,000 |
| Medical Deductible - Family: | $10,000 |
| Drug Deductible - Individual: | Included in Medical |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $6,550 |
| Out of Pocket Max - Family: | $13,100 |
| Primary Care Visit: | 20% Coinsurance after deductible |
| Specialist Visit: | 20% Coinsurance after deductible |
| Emergency Room: | 20% Coinsurance after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | http://www.summacare.com/Libraries/SBCs/2018SummaCareBronze5000HSASCConnectNetwork.sflb |
| Plan Brochure: | http://www.summacare.com/Libraries/SOBs/2018SummaCareBronze5000HSASCConnectNetwork.sflb |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | 20% Coinsurance after deductible |
| Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Preferred Brand Drugs: | 20% Coinsurance after deductible |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb |
This Carrier Offers:
About The Carrier
SummaCare offers affordable medical insurance for employers, individuals, families and Medicare eligible individuals. It is our goal to consistently exceed our members’ expectations. That’s why you can expect the same great customer service with every interaction you have with SummaCare.
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