QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I202 (2022) - Marinette - WI
43
InfoPreferred Score
Good
specifications
- Premium 370.68 Dollar(s)
- Deductibles 8700 Dollar(s)
- Out of Pocket Maximum 8700 Dollar(s)
- Covered Benefits 29 out of 40
Key Features
$ 370.68
Premium
Very Good
$ 8700
Deductibles
Poor
$ 8700
Out of Pocket Maximum
Poor
29 / 40
Covered Benefits
Average
-
Overview
Plan ID: 37833WI0510174Plan Type: HMOMetal Level: BronzeCovered Benefits: 29County: MarinetteFIPS County Code: 55075State: WISM Rating: 43 -
Cost of Medical Sharing
Premium: 370.68EHB Premium: 370.68EHB Percent of Total Premium: 100Deductibles: 8700Out of Pocket Maximum: 8700 -
Cost Sharing
Adult Dental Care Details: Benefit Not CoveredChild Dental Care Details: Benefit Not CoveredChild Dental Check Up: Benefit Not CoveredAdult Major Dental Care: Benefit Not CoveredChild Major Dental Care: Benefit Not CoveredAdult Routine Dental Services: Benefit Not CoveredEye Glasses for Children: No Charge After DeductibleAdult Routine Eye Exam Details: Benefit Not CoveredChild Routine Eye Exam Details: No ChargeHearing Aids Details: No Charge After DeductibleBariatric Surgery: Benefit Not CoveredChemotherapy: No Charge After DeductibleChiropractic Care: $60Dialysis: No Charge After DeductibleDurable Medical Equipment: No Charge After DeductibleEmergency Room Services: No Charge After DeductibleEmergency Transportation Ambulance: No Charge After DeductibleHabilitation Services: No Charge After DeductibleImaging (CT, Pet, MRIS Scan): No Charge After DeductibleInfertility Treatment: Benefit Not CoveredInpatient Hospital Services: No Charge After DeductibleInpatient Physician and Surgical Services: No Charge After DeductibleLaboratory Outpatient and Professional Services: No Charge After DeductibleMental Behavioral Health Inpatient Services: No Charge After DeductibleMental Behavioral Health Outpatient Services: $60Adult Orthodontia: Benefit Not CoveredChild Orthodontia: Benefit Not CoveredOutpatient Facility Fee: No Charge After DeductibleOutpatient Rehabilitation Services: No Charge After DeductibleOutpatient Surgery Services: No Charge After DeductiblePreventive Care Screening Immunization: No ChargePrimary Care Visit: $60Private Duty Nursing: Benefit Not CoveredSkilled Nursing Facility: No Charge After DeductibleSpecialist Visit: $100XRays and Diagnostic Imaging: No Charge After Deductible -
Prescription Drug Coverage
List of Covered Drugs URL: https://quartzbenefits.com/drugformulary/metalGeneric Drugs: No Charge After DeductibleNon Preferred Brand Drugs: No Charge After DeductiblePreferred Brand Drugs: No Charge After DeductibleSpecialty Drugs: No Charge After Deductible -
Benefits
Dental Benefits: 0Vision Benefits: 2Hearing Benefits: 1Other Benefits: 26Adult Dental Care:Child Dental Care:Adult Routine Eye Exam:Child Routine Eye Exam: 1Hearing Aids: 1National Network Available:Health Savings Account Eligibility:Disease Management Programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure and High Cholesterol, Pregnancy -
Plan Documents
Provider Directory URL: https://quartzbenefits.com/quartz-oneBenefits Summary URL: https://apps.quartzbenefits.com/sbc/Document.aspx?t=Q1B225117401Brochure URL: https://QuartzBenefits.com/2022/Quartz-One/3 -
Policy Issuer Details
Eligible Dependents: Self, Spouse, Child, Stepson or Stepdaughter, Grandson or Granddaughter, Life Partner, Foster Child, WardIssuer: QuartzIssuer ID: 37833Issuer Shop URL: https://quartzbenefits.com/contactusCustomer Service Toll free Number: 1-800-362-3310Area: Rating Area 16
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70
InfoPreferred Score
Good