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Medica with CHI Health Bronze HSA
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Medica with CHI Health Bronze HSA

Overview
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Medica with CHI Health Bronze HSA is an individual health health plan issued by Medica 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 Saunders county, Nebraska.

What Type of Health Plan Is This?

This plan is an EPO plan, which is also known as an "Exclusive Provider Organization." An EPO is a managed care plan where services are covered so long as the the hospitals, dentists, and other health providers in the plan's network are used.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
Medica Insurance Company
Plan ID
20305NE0050011
Coverage area
Saunders County, Nebraska
Phone
Local Phone: 1-888-592-8211
Toll-Free: 1-888-592-8211
TTY: 1-800-833-7352
Plan type
EPO
Coverage type
Medical deductible
$6,200
Out-of-pocket maximum
$6,750
Generic drug co-pay
20% Coinsurance after deductible
Preferred brand drug co-pay
20% Coinsurance after deductible
Primary care physician visit cost
20% Coinsurance after deductible
Specialist doctor visit cost
20% Coinsurance after deductible
Doctor Visits
Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Emergency Room Visit 20% Coinsurance after deductible
Inpatient Facility Visit 20% Coinsurance after deductible
Inpatient Physician Visit 20% Coinsurance after deductible
Prescription Drugs
Generic Drugs 20% Coinsurance after deductible
Preferred Brand Drugs 20% Coinsurance after deductible
Non-preferred Brand Drugs 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $6,200
Medical Maximum Out Of Pocket (Individual) $6,750
Medical Deductible (Family) $12,400
Medical Maximum Out Of Pocket (Family) $13,500
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 100.00%
Premium Child Age 0-14 301
Premium Child Age 18 359
Premium Adult Individual Age 21 394
Premium Adult Individual Age 27 413
Premium Adult Individual Age 30 447
Premium Adult Individual Age 40 503
Premium Adult Individual Age 50 703
Premium Adult Individual Age 60 1,069
Premium Couple 21 788
Premium Couple 30 894
Premium Couple 40 1,007
Premium Couple 50 1,407
Premium Couple 60 2,139
Couple+1 child, Age 21 1,089
Couple+1 child, Age 30 1,196
Couple+1 child, Age 40 1,308
Couple+1 child, Age 50 1,709
Couple+2 children, Age 21 1,391
Couple+2 children, Age 30 1,497
Couple+2 children, Age 40 1,610
Couple+2 children, Age 50 2,010
Couple+3 or more Children, Age 21 1,692
Couple+3 or more Children, Age 30 1,799
Couple+3 or more Children, Age 40 1,911
Couple+3 or more Children, Age 50 2,312
Individual+1 child, Age 21 695
Individual+1 child, Age 30 748
Individual+1 child, Age 40 805
Individual+1 child, Age 50 1,005
Individual+2 children, Age 21 997
Individual+2 children, Age 30 1,050
Individual+2 children, Age 40 1,106
Individual+2 children, Age 50 1,306
Individual+3 or more children, Age 21 1,298
Individual+3 or more children, Age 30 1,351
Individual+3 or more children, Age 40 1,408
Individual+3 or more children, Age 50 1,608
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