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Medica Insurance Company

Balance by Medica Bronze Copay $0 Primary Care ($0 Virtual Care + Online Wellness)

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $7,500
    • Family: $15,000
    • Per Person: $7,500
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: $0.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    Specialist
    • CoPay: $150.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: $200.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: Prescription insulin will not exceed $25 per prescription unit
    Non Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 70.00% Coinsurance after deductible
    • Covered: Covered
    Generic Drugs
    • CoPay: $25.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    Specialty Drugs
    • CoPay: $750.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Inpatient Coverage

    Hospital Services
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    Inpatient Services
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    Urgent Care Facility
    • CoPay: $0.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    Pre and Postnatal Office Visit
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: $0.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 1
    • Limit Unit : Exam(s) per Benefit Period

    Major Dental Care

    Routine Dental Checkups for Children
    • Covered: Not Covered
    Routine Dental Checkups for Adults
    • Covered: Not Covered
    Basic Dental Care - Adult
    • Covered: Not Covered
    Basic Dental Care - Child
    • Covered: Not Covered
    Major Dental Care - Adult
    • Covered: Not Covered
    Major Dental Care - Child
    • Covered: Not Covered
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