QUARTZ SELECT BRONZE (DENTAL & VISION) $10,900 DED FLAT PCP COPAY LIMITED COST SHARE

Quartz Health Plan MN Corporation · 2027 plan year

Expanded BronzeHSA eligible

Ind. deductible: $10,900
Family deductible: $21,800
Ind. OOP max: $11,000
Family OOP max: $22,000

Other cost-sharing reduction variants for this plan:

Standard Bronze Off Exchange Plan Standard Bronze On Exchange Plan Zero Cost Sharing Plan Variation

More Quartz Health Plan MN Corporation plans in MN

QUARTZ SELECT SILVER (VISION) $8,500 DED QUARTZ SELECT BRONZE (VISION) $8,500 HSA QUARTZ SELECT CATASTROPHIC (VISION) $12,000 DED QUARTZ SELECT GOLD MAINTENANCE (VISION) $700 DED QUARTZ EASY COMPARE GOLD FLAT RX COPAYS (VISION) SELECT

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$85.00

Specialist

Benefit	In-network
Specialist Visit	50.00% Coinsurance after deductible

Hospital

Benefit	In-network
Emergency Room Services	50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	50.00% Coinsurance after deductible
Urgent Care Centers or Facilities	50.00% Coinsurance after deductible

Pharmacy

Benefit	In-network
Generic Drugs	$15.00
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Preferred Brand Drugs	$250.00
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$85.00

Other

Benefit	In-network
Clinical Trials	50.00% Coinsurance after deductible
Routine Eye Exam (Adult)	$85.00
Routine Eye Exam for Children	$85.00
Routine Foot Care	50.00% Coinsurance after deductible
Chiropractic Care	$85.00
Abortion for Which Public Funding is Prohibited	50.00% Coinsurance after deductible
Accidental Dental	50.00% Coinsurance after deductible
Acupuncture	50.00% Coinsurance after deductible
Allergy Testing	50.00% Coinsurance after deductible
Basic Dental Care - Adult	20.00%
Basic Dental Care - Child	30.00%
Chemotherapy	50.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	50.00% Coinsurance after deductible
Dental Check-Up for Children	No charge
Diabetes Education	50.00% Coinsurance after deductible
Dialysis	50.00% Coinsurance after deductible
Durable Medical Equipment	50.00%
Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Eye Glasses for Children	50.00%
Gender Affirming Care	50.00% Coinsurance after deductible
Habilitation Services	50.00% Coinsurance after deductible
Hearing Aids	50.00%
Home Health Care Services	50.00% Coinsurance after deductible
Hospice Services	50.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	50.00% Coinsurance after deductible
Infusion Therapy	50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	50.00% Coinsurance after deductible
Major Dental Care - Adult	50.00%
Major Dental Care - Child	50.00%
Nutritional Counseling	$85.00
Orthodontia - Child	50.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)	$85.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	50.00% Coinsurance after deductible
Outpatient Rehabilitation Services	50.00% Coinsurance after deductible
PANDAS/PANS	50.00% Coinsurance after deductible
Prenatal and Postnatal Care	No charge
Prosthetic Devices	50.00%
Radiation	50.00% Coinsurance after deductible
Reconstructive Surgery	50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	50.00% Coinsurance after deductible
Rehabilitative Speech Therapy	50.00% Coinsurance after deductible
Routine Dental Services (Adult)	No charge
Skilled Nursing Facility	50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$85.00
Transplant	50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	50.00% Coinsurance after deductible
Virtual Visit	No charge
Well Baby Visits and Care	No charge
Wigs	50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	50.00% Coinsurance after deductible

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