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Bronze Pro EPO by Healthfirst New York

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Plan Information

Plan Name
Bronze Pro EPO
Insurance Company
Healthfirst New York

In Network Benefits

Office Co-pay
20% after deductible
Specialist Co-pay
20% after deductible
Hospital Co-pay
20% after deductible
Emergency Room
20% after deductible
Referrals Needed
No
Rx: Generic/Brand/High Brand
20% after deductible
In-Network Deductible (single/family)
$5,000/$10,000
In-Network Co-Insurance
20%
Max Out of Pocket (single/family)
$6,550/$13,100

Out Of Network Benefits

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

Other Benefits

Vision/Dental
Pediatric Vision and Dental
Renewal Date
Annual
HSA Eligible
No

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