QUARTZ ONE ACHIEVE W/GUNDERSEN GOLD MAINTENANCE $700 DED
Quartz · 2026 plan year
Gold
- Ind. medical deductible
- $700
- Rx deductible (separate)
- $0
- Family deductible
- $1,400
- Ind. OOP max
- $9,300
- Family OOP max
- $18,600
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Gold plans in WI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Quartz plans in WI
Monthly premiums by age
Rating Area 6 — the lowest-priced of the 3 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $453 | $453 |
| 21 | $592 | $651 |
| 30 | $672 | $739 |
| 40 | $756 | $832 |
| 50 | $1,057 | $1,163 |
| 60 | $1,606 | $1,767 |
| 64 and over | $1,775 | $1,953 |
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 | $40.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $80.00 |
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital Services (e.g., Hospital Stay) | $2500.00 Copay per Day |
| Emergency Room Services | $550.00 |
| Outpatient Surgery Physician/Surgical Services | No Charge after deductible |
| Urgent Care Centers or Facilities | $75.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $5.00 |
| Non-Preferred Brand Drugs | 50.00% |
| Preferred Brand Drugs | $50.00 |
| Specialty Drugs | 60.00% |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $2500.00 Copay per Day |
| Mental/Behavioral Health Outpatient Services | $40.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | No Charge after deductible |
| Acupuncture | Not covered |
| Allergy Testing | Not covered |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | No Charge after deductible |
| Chiropractic Care | $40.00 |
| Clinical Trials | No Charge after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $2,500.00 |
| Dental Anesthesia | No Charge after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Care Management | $40.00 |
| Diabetes Education | No Charge after deductible |
| Dialysis | No Charge after deductible |
| Durable Medical Equipment | No charge |
| Emergency Transportation/Ambulance | No Charge after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | No Charge after deductible |
| Habilitation Services | $50.00 Copay after deductible |
| Hearing Aids | No charge |
| Home Health Care Services | No Charge after deductible |
| Hospice Services | No Charge after deductible |
| Imaging (CT/PET Scans, MRIs) | $150.00 Copay after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | No Charge after deductible |
| Inpatient Physician and Surgical Services | No Charge after deductible |
| Laboratory Outpatient and Professional Services | $40.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | $40.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $40.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | No Charge after deductible |
| Outpatient Rehabilitation Services | $50.00 Copay after deductible |
| Prenatal and Postnatal Care | $40.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | No charge |
| Radiation | No Charge after deductible |
| Reconstructive Surgery | No Charge after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $50.00 Copay after deductible |
| Rehabilitative Speech Therapy | $50.00 Copay after deductible |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $40.00 |
| Routine Foot Care | No Charge after deductible |
| Skilled Nursing Facility | $2500.00 Copay per Day |
| Substance Abuse Disorder Inpatient Services | $2500.00 Copay per Day |
| Substance Abuse Disorder Outpatient Services | $40.00 |
| Transplant | No Charge after deductible |
| Treatment for Temporomandibular Joint Disorders | No Charge after deductible |
| Virtual Visit | No charge |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $80.00 |
Plan rules
Service area
This plan covers 6 geographic areas.
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