QUARTZ ONE ACHIEVE W/UW HEALTH BRONZE (DENTAL & VISION) $0 MEDICAL DED

Quartz · 2026 plan year

Expanded BronzeHSA eligible
Ind. medical deductible
$0
Rx deductible (separate)
$2,250
Family deductible
$0
Ind. OOP max
$10,400
Family OOP max
$20,800

This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.

Compare with other Expanded Bronze plans in WI

Side by side: deductibles, out-of-pocket limits and copays.

More Quartz plans in WI

Monthly premiums by age

Rating Area 2 — the lowest-priced of the 3 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$305$305
21$398$438
30$452$497
40$509$560
50$712$783
60$1,081$1,189
64 and over$1,195$1,315

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$80.00

Specialist

BenefitIn-network
Specialist Visit$160.00

Hospital

BenefitIn-network
Urgent Care Centers or Facilities$175.00
Emergency Room Services$1,500.00
Inpatient Hospital Services (e.g., Hospital Stay)$3000.00 Copay per Day
Outpatient Surgery Physician/Surgical Services50.00%

Pharmacy

BenefitIn-network
Generic Drugs$15.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$200.00
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$3000.00 Copay per Day
Mental/Behavioral Health Outpatient Services$80.00

Other

BenefitIn-network
Transplant50.00%
Treatment for Temporomandibular Joint Disorders50.00%
Virtual VisitNo charge
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$200.00
Bariatric SurgeryNot covered
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental50.00%
AcupunctureNot covered
Allergy TestingNot covered
Basic Dental Care - Adult20.00%
Basic Dental Care - Child30.00%
Chemotherapy50.00%
Chiropractic Care$80.00
Clinical Trials50.00%
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care$3,000.00
Dental Anesthesia50.00%
Dental Check-Up for ChildrenNo charge
Diabetes Care Management$80.00
Diabetes Education50.00%
Dialysis50.00%
Durable Medical Equipment50.00%
Emergency Transportation/Ambulance50.00%
Eye Glasses for Children50.00%
Gender Affirming Care50.00%
Habilitation Services$155.00
Hearing Aids50.00%
Home Health Care Services50.00%
Hospice Services50.00%
Imaging (CT/PET Scans, MRIs)$1,000.00
Infertility TreatmentNot covered
Infusion Therapy50.00%
Inpatient Physician and Surgical Services50.00%
Laboratory Outpatient and Professional Services$100.00
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - Adult50.00%
Major Dental Care - Child50.00%
Nutritional Counseling$80.00
Orthodontia - AdultNot covered
Orthodontia - Child50.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)$80.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$2,000.00
Outpatient Rehabilitation Services$155.00
Prenatal and Postnatal Care$80.00
Private-Duty NursingNot covered
Prosthetic Devices50.00%
Radiation50.00%
Reconstructive Surgery50.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy$155.00
Rehabilitative Speech Therapy$155.00
Routine Dental Services (Adult)No charge
Routine Eye Exam (Adult)$80.00
Routine Eye Exam for Children$80.00
Routine Foot Care50.00%
Skilled Nursing Facility$3000.00 Copay per Day
Substance Abuse Disorder Inpatient Services$3000.00 Copay per Day
Substance Abuse Disorder Outpatient Services$80.00

Plan rules

Service area

This plan covers 4 geographic areas.

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