Advantage Gold NS by Univera Healthcare
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Advantage Gold NS
- Insurance Company
- Univera Healthcare
In Network Benefits
- Office Co-pay
- $15 after deductible
- Specialist Co-pay
- $50 after deductible
- Hospital Co-pay
- $380 after deductible
- Emergency Room
- $90 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $0/$50/50% after deductible
- In-Network Deductible (single/family)
- $1,400/$2,800
- In-Network Co-Insurance
- $0
- Max Out of Pocket (single/family)
- NA
Out Of Network Benefits
Other Benefits
- Vision/Dental
- Vision and Pediatric Vision
- Renewal Date
- 01-01-2021
- HSA Eligible
- No
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