Bronze ST by Univera Healthcare
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Bronze ST
- Insurance Company
- Univera Healthcare
In Network Benefits
- Office Co-pay
- $75 after deductible
- Specialist Co-pay
- $0
- 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)
- $4,700/$9,400
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $8,550/$17,100
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
- 12-31-2021
- HSA Eligible
- No
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