INDIVIDUAL PLAN COVERAGE
Coverage Highlights Deductible Plans
The information below provides a summary of benefits and is not all-inclusive.
|
IN-NETWORK |
OUT-OF NETWORK |
PLAN NAME |
PreferredHealth Silver 26 |
PreferredHealth Expanded Bronze 27 |
|
PLAN TYPE |
HSA qualified |
HSA qualified |
NETWORK |
PreferredHealth |
PreferredHealth |
DEDUCTIBLE |
$3,000 individual or $6,000 family ($3,000 per family member) |
$7,000 individual or $14,000 family ($7,000 per family member) |
$15000 individual or $25000 family |
COINSURANCE (% YOU PAY AFTER DEDUCTIBLE) |
20% |
0% |
50% |
OUT-OF-POCKET MAXIMUM |
$6,900 individual or $13,800 family ($6,900 per family member) |
$7,000 individual or $14,000 family ($7,000 per family member) |
Unlimited |
PRESCRIPTION DRUG COVERAGE FORMULARY, 31 DAY SUPPLY ONLY
*NO COVERAGE FOR NON-FORMULARY |
Generic: 20% after deductible Brand formulary: 20% after deductible Specialty: 50% after deductible |
Generic: You pay nothing after deductible Brand formulary: You pay nothing after deductible Specialty: You pay nothing after deductible |
Not covered |
INSULIN ON FORMULARY |
$25 copay |
$25 copay |
Coverage Highlights Copay Plans
The information below provides a summary of benefits and is not all-inclusive.
|
IN-NETWORK |
OUT-OF NETWORK |
PLAN NAME |
PreferredHealth Gold 28 |
PreferredHealth Silver 29 |
PreferredHealth Silver 31 |
PreferredHealth Expanded Bronze 30 |
|
PLAN TYPE |
Copay |
Copay |
Copay |
Copay |
NETWORK |
PreferredHealth |
PreferredHealth |
PreferredHealth |
PreferredHealth |
DEDUCTIBLE |
$1,850 individual or
$3,700 family
($1,850 per family member) |
$3,800 individual or
$7,600 family
($3,800 per family member) |
$4,700 individual or
$9,400 family
($4,700 per family member) |
$8,550 individual or
$17,100 family
($8,550 per family member) |
$15000 individual or
$25000 family |
COINSURANCE (% YOU PAY AFTER DEDUCTIBLE) |
20% |
30% |
25% |
0% |
50% |
OUT-OF-POCKET MAXIMUM |
$7,100 individual or
$14,200 family
($7,100 per family
member) |
$8,400 individual or
$16,800 family
($8,400 per family
member) |
$8,500 individual or
$17,000 family
($8,500 per family
member) |
$8,550 individual or
$17,100 family
($8,550 per family
member) |
Unlimited |
OFFICE VISITS |
$25 copay |
$45 copay |
$50 copay |
$125 copay |
You pay 50% after deductible |
SPECIALIST OFFICE VISITS |
$50 copay |
$60 copay |
$75 copay |
$175 copay |
PRESCRIPTION DRUG COVERAGE
FORMULARY, 31 DAY SUPPLY ONLY
*NO COVERAGE FOR NON-FORMULARY |
Generic: $5 copay
Brand formulary:
40% after deductible
Specialty: 50% after
deductible |
Generic: $25 copay
Brand formulary:
30% after deductible
Specialty:
50% after deductible |
Generic: $15 copay
Brand formulary:
25% after deductible
Specialty:
50% after deductible |
Generic: $35 copay
Brand formulary:
you pay nothing after
deductible |
Not covered |
INSULIN ON FORMULARY |
$25 copay |
$25 copay |
$25 copay |
$25 copay |
Get a Quote
Get a monthly quote and enroll online.
Coverage Information
Select the items below to learn more about the PreferredHealth plan for individuals.
Individual and Family Plans Brochure
Member Assistance Program
Supplemental Accident Coverage
Summary of Benefits and Coverage (SBCs)
Select the plan below to view the SBC.
PreferredHealth Silver 26
PreferredHealth Expanded Bronze 27
PreferredHealth Gold 28
PreferredHealth Silver 29
PreferredHealth Expanded Bronze 30
PreferredHealth Silver 31
Certificate of Coverage
PreferredHealth Silver 26
PreferredHealth Expanded Bronze 27
PreferredHealth Gold 28
PreferredHealth Silver 29
PreferredHealth Expanded Bronze 30
PreferredHealth Silver 31
Coverage Highlights
- Vision Exam 100% coverage
- Eye Glasses or Contacts–one set per year (subject to deductible and coinsurance).
Member Assistance Program
PreferredOne has partnered with Fairview to offer free support for your emotional well-being with Member Assistance Program, benefits to our members include but are not limited to:
- 3 free counseling appointments per person/per episode
- 24/7 counselor access for urgent needs
- Legal Services
- Financial assistance
- Family and marital concerns
- Work/life balance
- Anxiety
- Depression
- Eldercare concerns
Have a Question?
Call between 8:00 a.m. and 4:30 p.m. CST, Monday through Friday. Twin Cities Area: 763.847.3020 Outside the Metro Area: 1.855.717.5267 For Hearing Impaired: 763.847.4013 (TTY).