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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 Pawnee 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
Pawnee 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 0-14 275
Premium Child Age 18 328
Premium Adult Individual Age 21 359
Premium Adult Individual Age 27 377
Premium Adult Individual Age 30 408
Premium Adult Individual Age 40 459
Premium Adult Individual Age 50 642
Premium Adult Individual Age 60 976
Premium Couple 21 719
Premium Couple 30 816
Premium Couple 40 919
Premium Couple 50 1,285
Premium Couple 60 1,952
Couple+1 child, Age 21 994
Couple+1 child, Age 30 1,091
Couple+1 child, Age 40 1,194
Couple+1 child, Age 50 1,560
Couple+2 children, Age 21 1,269
Couple+2 children, Age 30 1,367
Couple+2 children, Age 40 1470
Couple+2 children, Age 50 1,835
Couple+3 or more Children, Age 21 1,545
Couple+3 or more Children, Age 30 1,642
Couple+3 or more Children, Age 40 1,745
Couple+3 or more Children, Age 50 2,110
Individual+1 child, Age 21 634
Individual+1 child, Age 30 683
Individual+1 child, Age 40 735
Individual+1 child, Age 50 917
Individual+2 children, Age 21 910
Individual+2 children, Age 30 958
Individual+2 children, Age 40 1,010
Individual+2 children, Age 50 1,192
Individual+3 or more children, Age 21 1,185
Individual+3 or more children, Age 30 1,233
Individual+3 or more children, Age 40 1,285
Individual+3 or more children, Age 50 1,468
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