WellSense Clarity NH Bronze 6500 HSA + $0 Rx List + 24/7 Nurse Advice
WellSense Health Plan · 2026 plan year
Expanded BronzeHSA eligible
- Ind. deductible
- $6,500
- Family deductible
- $13,000
- Ind. OOP max
- $10,600
- Family OOP max
- $21,200
Compare with other Expanded Bronze plans in NH
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More WellSense Health Plan plans in NH
Monthly premiums by age
Rating Area 1
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $190 | $190 |
| 21 | $248 | $285 |
| 30 | $281 | $324 |
| 40 | $317 | $364 |
| 50 | $443 | $509 |
| 60 | $673 | $774 |
| 64 and over | $744 | $855 |
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 | $45.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $90.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 40.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 40.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $70.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | 25.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | 40.00% Coinsurance after deductible |
| Preferred Brand Drugs | 35.00% Coinsurance after deductible |
| Specialty Drugs | 45.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 40.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $45.00 |
Other
| Benefit | In-network |
|---|---|
| Prosthetic Devices | 40.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 40.00% Coinsurance after deductible |
| Acupuncture | $45.00 |
| Allergy Testing | $90.00 |
| Bariatric Surgery | 40.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | No Charge after deductible |
| Chiropractic Care | $90.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 40.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | 40.00% Coinsurance after deductible |
| Dialysis | 40.00% Coinsurance after deductible |
| Durable Medical Equipment | 40.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 40.00% Coinsurance after deductible |
| Eye Glasses for Children | 40.00% Coinsurance after deductible |
| Radiation | No Charge after deductible |
| Reconstructive Surgery | 40.00% Coinsurance after deductible |
| Habilitation Services | 40.00% Coinsurance after deductible |
| Hearing Aids | 40.00% Coinsurance after deductible |
| Home Health Care Services | 40.00% Coinsurance after deductible |
| Hospice Services | 40.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 40.00% Coinsurance after deductible |
| Infertility Treatment | 40.00% Coinsurance after deductible |
| Infusion Therapy | 40.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 40.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 40.00% 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 | 40.00% Coinsurance after deductible |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $45.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 40.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 40.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | Not covered |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 40.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 40.00% Coinsurance after deductible |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $90.00 |
| Routine Foot Care | $90.00 |
| Skilled Nursing Facility | 40.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 40.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $45.00 |
| Transplant | 40.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | $90.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 40.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 5 geographic areas.
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