METRO AREA COVERAGE

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	Generic: 20% after deductible Brand formulary: 20% after deductible Non-formulary: 20% after deductible Specialty: 50% after deductible	Generic: You pay nothing after deductible Brand formulary: You pay nothing after deductible Non-formulary: You pay nothing after deductible Specialty: You pay nothing after deductible	Not covered
INSULIN ON FORMULARY	$25 copay	$25 copay	Not covered

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	$2,250 individual or $4,500 family ($2,250 per family member)	$4,950 individual or $9,900 family ($4,950 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	$8,200 individual or $16,400 family ($8,200 per family member)	$9,100 individual or $18,200 family ($9,100 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	$55 copay	$50 copay	$125 copay	You pay 50% after deductible
SPECIALIST OFFICE VISITS	$50 copay	$70 copay	$75 copay	$175 copay	You pay 50% after deductible
PRESCRIPTION DRUG COVERAGE FORMULARY, 31 DAY SUPPLY ONLY	Generic: $5 copay Brand formulary: 40% after deductible Non-formulary: 40% after deductible Specialty: 50% after deductible	Generic: $25 copay Brand formulary: 30% after deductible Non-formulary: 30% after deductible Specialty: 50% after deductible	Generic: $15 copay Brand formulary: 25% after deductible Non-formulary: 25% after deductible Specialty: 50% after deductible	Generic: $35 copay Brand formulary: you pay nothing after deductible Non-formulary: you pay nothing after deductible Specialty: 50% after deductible	Not covered
INSULIN ON FORMULARY	$25 copay	$25 copay	$25 copay	$25 copay	Not covered

Find a Doctor

Find a Doctor in the PreferredHealth Network.

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

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

100% coverage for preventive care.
Primary care and specialty care coverage.
Prescription benefit.
Emergency care when out of town.
Online Fitness Program.
Your covered children (under age 19) benefit from vision care.

Vision Exam 100% coverage
Eye Glasses or Contacts–one set per year (subject to deductible and coinsurance).

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).