Paramount Economy Bronze NCO, Plus Adult Dental & Vision Off Exchange

Paramount

Expanded BronzeHSA eligible

Ind. deductible: $6,500
Family deductible: $6,500
Ind. OOP max: $10,000
Family OOP max: $10,000

Other cost-sharing reduction variants for this plan:

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

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$443	—
30	$503	—
40	$567	—
50	$792	—
60	$1,203	—

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	No Charge after deductible

Specialist

Benefit	In-network
Specialist Visit	No charge

Hospital

Benefit	In-network
Emergency Room Services	No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Outpatient Surgery Physician/Surgical Services	0.00% Coinsurance after deductible
Urgent Care Centers or Facilities	No Charge after deductible

Pharmacy

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

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Mental/Behavioral Health Outpatient Services	No Charge after deductible

Other

Benefit	In-network
Routine Dental Services (Adult)	No charge
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
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	0.00% Coinsurance after deductible
Chiropractic Care	0.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	0.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	No charge
Dialysis	No charge
Durable Medical Equipment	0.00% Coinsurance after deductible
Emergency Transportation/Ambulance	No charge
Eye Glasses for Children	No charge
Habilitation Services	0.00% Coinsurance after deductible
Hearing Aids	Not covered
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	0.00% Coinsurance after deductible
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	No charge
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	No charge
Routine Eye Exam (Adult)	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	No charge
Private-Duty Nursing	0.00% Coinsurance after deductible
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	No charge
Rehabilitative Speech Therapy	0.00% Coinsurance after deductible
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	No Charge after deductible
Substance Abuse Disorder Outpatient Services	No charge
Transplant	No charge
Treatment for Temporomandibular Joint Disorders	No charge
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	0.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 3 geographic areas.