Bronze Plan


Bronze Plans have the lowest monthly premiums and the highest member cost-sharing.

For more information, contact us at: 1-888-249-2583.





Healthy Balance POS 8100 Pkg 2
In-Network:
     Deductible (single/family) $3,500 / $7,000
     Coinsurance 20%
     Out-of-Pocket Maximum (single/family) $6,350 / $12,700
Medical Services:
     PCP/Specialist Visit 20% after deductible
Hospital Services:
     Inpatient Hospital 25% after deductible
     Outpatient Surgery 25% after deductible
     Emergency Room Visit 20% after deductible
     Urgent Care 20% after deductible
Prescription Drugs*
     Generic/Formulary/Non-Formulary $15 / $50 / 50% after deductible
Rates (Single/Family):
     Single $325
     Employee/Child $553
     EMployee/Spouse $650
     Family $926
     Pediatric Dental Rate $19





*Generic oral contraceptives are covered in full.
*Mail order drugs are 2.5 copays / 90 day supply.
*Pediatric Dental is an essential health benefit required for dependents under the age of 19. Optional coverage is available with all plans.