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Bronze Plan HSA1
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Bronze Plan HSA1

Overview
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Bronze Plan HSA1 is an individual health health plan issued by USAble Mutual Insurance Company and is available for the year 2019. This health plan is offered by the federal government through HealthCare.gov and the Affordable Care Act (ACA).

Where Do I Need to Live to Quality for this Plan?

This plan is available for qualifying individuals who live in White county, Arkansas.

What Type of Health Plan Is This?

This plan is a PPO plan, which is also known as a "Preferred Provider Organization." In this type of insurance plan, you can choose to receive care from doctors, hospitals, and other providers who are in-network or out-of-network. You pay less if you use in-network providers. In a PPO plan, you can visit any doctor without getting a referral.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
USAble Mutual Insurance Company
Plan ID
75293AR1200008
Coverage area
White County, Arkansas
Phone
Local Phone: 1-800-800-4298
Toll-Free: 1-800-800-4298
TTY: 1-800-800-4298
Plan type
PPO
Coverage type
Medical deductible
$6,400
Out-of-pocket maximum
$6,650
Generic drug co-pay
$30 Copay after deductible
Preferred brand drug co-pay
$60 Copay after deductible
Primary care physician visit cost
10% Coinsurance after deductible
Specialist doctor visit cost
10% Coinsurance after deductible
Doctor Visits
Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Emergency Room Visit 10% Coinsurance after deductible
Inpatient Facility Visit 10% Coinsurance after deductible
Inpatient Physician Visit 10% Coinsurance after deductible
Prescription Drugs
Generic Drugs $30 Copay after deductible
Preferred Brand Drugs $60 Copay after deductible
Non-preferred Brand Drugs $120 Copay after deductible
Specialty Drugs $225 Copay after deductible
Medical Deductible
Medical Deductible (Individual) $6,400
Medical Maximum Out Of Pocket (Individual) $6,650
Medical Deductible (Family) $12,800
Medical Maximum Out Of Pocket (Family) $13,300
Drug Deductible
Drug Deductible (Individual) Included in Medical
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) Included in Medical
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 99.59%
Premium Child Age 0-14 191
Premium Child Age 18 228
Premium Adult Individual Age 21 250
Premium Adult Individual Age 27 262
Premium Adult Individual Age 30 284
Premium Adult Individual Age 40 319
Premium Adult Individual Age 50 447
Premium Adult Individual Age 60 679
Premium Couple 21 500
Premium Couple 30 568
Premium Couple 40 639
Premium Couple 50 894
Premium Couple 60 1359
Couple+1 child, Age 21 692
Couple+1 child, Age 30 759
Couple+1 child, Age 40 831
Couple+1 child, Age 50 1,085
Couple+2 children, Age 21 883
Couple+2 children, Age 30 951
Couple+2 children, Age 40 1023
Couple+2 children, Age 50 1,277
Couple+3 or more Children, Age 21 1,075
Couple+3 or more Children, Age 30 1,142
Couple+3 or more Children, Age 40 1,214
Couple+3 or more Children, Age 50 1,468
Individual+1 child, Age 21 441
Individual+1 child, Age 30 475
Individual+1 child, Age 40 511
Individual+1 child, Age 50 638
Individual+2 children, Age 21 633
Individual+2 children, Age 30 667
Individual+2 children, Age 40 703
Individual+2 children, Age 50 830
Individual+3 or more children, Age 21 824
Individual+3 or more children, Age 30 858
Individual+3 or more children, Age 40 894
Individual+3 or more children, Age 50 1,021
Reference
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  • HealthCare.gov. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov
  • The 'metal' categories: Bronze, Silver, Gold & Platinum. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plans-categories
  • Health insurance plan & network types: HMOs, PPOs, and more. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plan-types