HMO Catastrophic 10600 with 3 free PCP visits

Aspirus Health Plan

CatastrophicHSA eligible

Ind. deductible: $10,600
Family deductible: $10,600
Ind. OOP max: $10,600
Family OOP max: $10,600

Other cost-sharing reduction variants for this plan:

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$351	—
30	$398	—
40	$448	—
50	$627	—
60	$952	—

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	0.00% Coinsurance after deductible

Specialist

Benefit	In-network
Specialist Visit	0.00% Coinsurance after deductible

Hospital

Benefit	In-network
Emergency Room Services	0.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	0.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	0.00% Coinsurance after deductible
Urgent Care Centers or Facilities	0.00% Coinsurance after deductible

Pharmacy

Benefit	In-network
Generic Drugs	0.00% Coinsurance after deductible
Non-Preferred Brand Drugs	0.00% Coinsurance after deductible
Preferred Brand Drugs	0.00% Coinsurance after deductible
Specialty Drugs	0.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	0.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	0.00% Coinsurance after deductible

Other

Benefit	In-network
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	0.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	0.00% Coinsurance after deductible
Autism Spectrum Disorders	0.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Chemotherapy	0.00% Coinsurance after deductible
Chiropractic Care	0.00% Coinsurance after deductible
Clinical Trials	0.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	0.00% Coinsurance after deductible
Dental Anesthesia	0.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Care Management	0.00% Coinsurance after deductible
Diabetes Education	0.00% Coinsurance after deductible
Dialysis	0.00% Coinsurance after deductible
Durable Medical Equipment	0.00% Coinsurance after deductible
Emergency Transportation/Ambulance	0.00% Coinsurance after deductible
Eye Glasses for Children	0.00% Coinsurance after deductible
Gender Affirming Care	0.00% Coinsurance after deductible
Habilitation Services	0.00% Coinsurance after deductible
Hearing Aids	0.00% Coinsurance after deductible
Home Health Care Services	0.00% Coinsurance after deductible
Hospice Services	0.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	0.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	0.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	0.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	0.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	Not covered
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	0.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	0.00% Coinsurance after deductible
Outpatient Rehabilitation Services	0.00% Coinsurance after deductible
Prenatal and Postnatal Care	0.00% Coinsurance after deductible
Private-Duty Nursing	Not covered
Prosthetic Devices	0.00% Coinsurance after deductible
Radiation	0.00% Coinsurance after deductible
Reconstructive Surgery	0.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	0.00% Coinsurance after deductible
Rehabilitative Speech Therapy	0.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	0.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	0.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	0.00% Coinsurance after deductible
Transplant	0.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	0.00% Coinsurance after deductible
Virtual Care	No Charge after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	0.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	0.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 20 geographic areas.