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Compass HSA Bronze NS by United Healthcare

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Plan Information

Plan Name
Compass HSA Bronze NS
Insurance Company
United Healthcare

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
Yes
Rx: Generic/Brand/High Brand
$10/$35/$70 after deductible
In-Network Deductible (single/family)
$5,500/$11,000
In-Network Co-Insurance
50%
Max Out of Pocket (single/family)
$6,550/$13,100

Out Of Network Benefits

Co-Insurance
N/A
Out of Pocket Max (single/family)
N/A

Other Benefits

Vision/Dental
Pediatric Vision and Dental
Renewal Date
01/01/2018
HSA Eligible
Yes

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