Bronze ST by Fidelis Care
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Plan Information
- Plan Name
- Bronze ST
- Insurance Company
- Fidelis Care
In Network Benefits
- Office Co-pay
- 50% after deductible
- Specialist Co-pay
- 50% after deductible
- 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)
- $4,000/$8,000
- In-Network Co-Insurance
- 50%
- Max Out of Pocket (single/family)
- $7,150/$14,300
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
- Renewal Date
- 01/01/2018
- HSA Eligible
- No
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