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Premier Bronze 1 HDHP HSA by MVP

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Plan Information

Plan Name
Premier Bronze 1 HDHP HSA
Insurance Company
MVP

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 all after deductible
In-Network Deductible (single/family)
$5,500 / $11,000
In-Network Co-Insurance
50%
Max Out of Pocket (single/family)
$8,050 / $16,100

Out Of Network Benefits

Deductible (single/family)
N/A
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
12/31/2025
HSA Eligible
Yes

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