Bronze Standard HSA ST 2017 by Excellus
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Plan Information
- Plan Name
- Bronze Standard HSA ST 2017
- Insurance Company
- Excellus
In Network Benefits
- Office Co-pay
- 50% after deductible
- Specialist Co-pay
- 50% after deductible
- Hospital Co-pay
- 50% after deductible
- Emergency Room
- 50% after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$35/$70 after deductible
- In-Network Deductible (single/family)
- $5,500/$11,000
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $6,550/$12,900
Out Of Network Benefits
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision
- Renewal Date
- 01/01/2018
- HSA Eligible
- Yes
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