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Basic Plan

Serves as a safety net for large medical costs.


  • Simple plan option.
  • Premiums are typically lower.
  • Highest deductible plan.
  • No coinsurance to pay.

Good option if...

you would like a “safety net” to cover large medical costs in case of a major accident or illness.


Bronze Plan
HSA Eligible

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Participant deductible $9,100
Family deductible $18,200
Participant out-of-pocket $9,100
Family out-of-pocket $18,200


Participant Pays




Preventive Care Paid at 100% of maximum allowable amount at appropriate intervals when services are rendered by a network provider.
Primary Care



Subject to the deductible & coinsurance

Prescription Drugs
Tier 1: Generic DrugsTier 2: Preferred Brand drugs

Subject to the deductible & coinsurance

Subject to the deductible & coinsurance

Summary of Benefits and Coverage (SBC) View SBC »

At-a-Glance is intended to be a condensed overview of some plan benefits and does not cover all benefits or information contained in the Benefit Booklet.  Limitations and exclusions do exist.  At-a-Glance is not a contract.  For exact benefits and limitations, please request a copy of the Benefit Booklet.

Cost Assistance

Based on certain income requirements, you may qualify for assistance, through government subsidies, with your monthly premiums. 

Rx Tools

Find important information on your prescriptions, including how to select a pharmacy, request prescription benefits, and more.

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