ConnectiCare Benefits

Choice Bronze Standard POS HSA

Plan Overview

Medical Deductible
  • Individual: $6,500
  • Family: $13,000
  • Per Person: $6,500
Prescription Drug Deductible
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical
Medical Out-of-Pocket Maximum
  • Individual: $7,225
  • Family: $14,450
  • Per Person: $7,225
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: 20.00% Coinsurance after deductible
Specialist
  • Standard: 20.00% Coinsurance after deductible

Prescription Drug Information

Preferred Brand Drugs
  • Standard: 25.00% Coinsurance after deductible
Generic Drugs
  • Standard: 20.00% Coinsurance after deductible
Specialty Drugs
  • Standard: 30.00% Coinsurance after deductible to a maximum of $500 per prescription

Emergency and Urgent Care

Emergency Room
  • Standard: 20.00% Coinsurance after deductible