2018 Select by Medica Bronze H S A Plus Plan Details - HealthPocket

Select by Medica Bronze H S A Plus


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Zip Code66062
Applicant8/18/1983 Male
Coverage Start8/19/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameSelect by Medica Bronze H S A Plus
Plan IDqhp-39520KS0040023
Insurance ProviderMedica
Metal LevelExpanded Bronze
Plan TypeEPO
Out-of-Pocket Maximum$6,650
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness40% Coinsurance after deductible
Specialist Visit40% Coinsurance after deductible
Deductible - Family$5200
Out-of-Pocket Maximum - Family$13300

Prescription drug coverage

Generic Drugs40% Coinsurance after deductible
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs30% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible
PremiumPlan NameDeductible
from $61
National General 2500/50/5000/250000
from $76
National General 2500/20/4000/1000000
from $82
Short Term Medical Value 2500/30/12500
from $86
Short Term Medical Value 2500/30/7500
from $92
National General 2500/0/2500/1000000

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