Bronze Premier
| Plan Type: | EPO |
| Plan Tier: | Expanded Bronze |
| Medical Deductible - Individual: | $5000 |
| Medical Deductible - Family: | Included in Medical |
| Drug Deductible - Individual: | $5000 |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $8150 |
| Out of Pocket Max - Family: | $8150 |
| Primary Care Visit: | $25 |
| Specialist Visit: | 40% Coinsurance after deductible |
| Emergency Room: | 40% Coinsurance after deductible |
| Hospital - Physician: | 40% Coinsurance after deductible |
| Hospital - Facility: | 40% Coinsurance after deductible |
| Link to Full SBC: | https://cdn1.brighthealthplan.com/docs/2020_SBCs/SBC_12379FL0010007_01_20200101.pdf |
| Plan Brochure: | https://cdn1.brighthealthplan.com/docs/2020_COCs/COC_12379FL0010027_01_20200101.pdf |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $25 |
| Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Link to Full Policy Formulary: | https://brighthealthplan.com/drug-search/ifp/fl-ahn |
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