Bronze Blue Access EPO 5500 35 6700 HSA by Empire
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Bronze Blue Access EPO 5500 35 6700 HSA
- Insurance Company
- Empire
In Network Benefits
- Office Co-pay
- 35% after deductible
- Specialist Co-pay
- 35% after deductible
- Hospital Co-pay
- 35% after deductible
- Emergency Room
- 35% after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $15/$50/$90
- In-Network Deductible (single/family)
- $5,500/$11,000
- In-Network Co-Insurance
- 35%
- Max Out of Pocket (single/family)
- $6,700/$13,400
Out Of Network Benefits
- Deductible (single/family)
- N/A
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental; Adult Vision Only
- Renewal Date
- Annual
- HSA Eligible
- Yes
Check if you qualify for this Health Insurance plan:
Or give us a call, our expert agents will be happy to assist you. It's toll-free!