Sold outside the marketplace. This plan is bought directly from the insurer, so it is not eligible for a premium tax credit. If your income qualifies you for savings, a marketplace plan at the same price will usually cost you less.

WellSense Clarity NH Bronze 0 HSA + $0 Rx List + 24/7 Nurse Advice

WellSense Health Plan · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$0
Family deductible
$0
Ind. OOP max
$12,000
Family OOP max
$24,000

More WellSense Health Plan plans in NH

Monthly premiums by age

Rating Area 1

AgeIndividualIndividual + tobacco
Under 15$244$244
21$319$367
30$362$416
40$408$469
50$570$655
60$866$995
64 and over$957$1,100

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$75.00

Specialist

BenefitIn-network
Specialist Visit$120.00

Hospital

BenefitIn-network
Emergency Room Services$3,000.00
Inpatient Hospital Services (e.g., Hospital Stay)$3000.00 Copay per Stay
Outpatient Surgery Physician/Surgical Services$500.00
Urgent Care Centers or Facilities$75.00

Pharmacy

BenefitIn-network
Generic Drugs$30.00
Non-Preferred Brand Drugs45.00%
Preferred Brand Drugs$60.00
Specialty Drugs50.00%

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$3,000.00
Mental/Behavioral Health Outpatient Services$75.00

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental$3,000.00
Acupuncture$75.00
Allergy Testing$120.00
Bariatric Surgery$3,000.00
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Chemotherapy50.00%
Chiropractic Care$120.00
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care$3,000.00
Dental Check-Up for ChildrenNot covered
Diabetes Education50.00%
Dialysis50.00%
Durable Medical Equipment50.00%
Emergency Transportation/Ambulance$3,000.00
Eye Glasses for Children50.00%
Habilitation Services$75.00
Hearing Aids50.00%
Home Health Care Services50.00%
Hospice Services50.00%
Imaging (CT/PET Scans, MRIs)$300.00
Infertility Treatment50.00%
Infusion Therapy50.00%
Inpatient Physician and Surgical ServicesNo charge
Laboratory Outpatient and Professional Services$75.00
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling50.00%
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)$75.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$3,000.00
Outpatient Rehabilitation Services$75.00
Prenatal and Postnatal CareNo charge
Private-Duty NursingNot covered
Prosthetic Devices50.00%
Radiation50.00%
Reconstructive Surgery$3,000.00
Rehabilitative Occupational and Rehabilitative Physical Therapy$75.00
Rehabilitative Speech Therapy$75.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for Children$120.00
Routine Foot Care$120.00
Skilled Nursing Facility$3000.00 Copay per Stay
Substance Abuse Disorder Inpatient Services$3,000.00
Substance Abuse Disorder Outpatient Services$75.00
Transplant$3,000.00
Treatment for Temporomandibular Joint Disorders$120.00
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$75.00

Service area

This plan covers 5 geographic areas.

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