2021 Bright Health Plan Gold – HMO Option


Bright Health Illinois
Free Online Quote

Plan Brochure
2021 Plan Comparison
2021 Drug Formulary
$0 Rx List (including contraceptives)
Provider Directory

Bright Health Gold Overview

The Bright Health Gold Plan has generous coverage and predictable costs. . This plan is best for people who expect to use their coverage often: ongoing prescriptions, frequent provider visits, etc. Most benefits have copays, so costs are more predictable. Advanced Premium Tax Credits (APTC) can be used to lower monthly premium payments if you quality. Bright Health has a total of 1 Gold plan.

  • Gold 1000 – $1,000 individual deductible and 20% coinsurance.

Bright Health Gold 1000

Download Summary of Benefits and Coverage here
Plan Guide here
Find a doctor here

Important Questions Answers Why this Matters:
What is the overall deductible?$1,000 Individual or
$2,000 Family
See the Common Medical Events chart below for your costs for services this plan covers.
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there services covered before you meet your deductible?Yes. Primary Care, Specialty Care, Lab and Xray services, some Prescription Drugs, Urgent Care, Outpatient Mental Health, and Pediatric Dental and Vision are covered before the deductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket
limit for this plan?
$8,550 Individual or
$17,100 Family
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billed charges, and health care this plan doesn’t cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See
https://brighthealthplan.com/provider-finder/ifp or call 1-855-827-4448 for a list of network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
YesThis plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.

 

Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider (You will pay the least)

Your cost if you use
a Non-Participating
Provider (You will pay the most)

Limitations & Exceptions, & Other Important Information
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$0 first 2 visits, then $20

Not covered

No charge for first 2 visits, then $20 per visit
Specialist visit

$40

Not covered

None
Preventive care/screening/immunization

No charge

Not covered

You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

Labs $50 per visit X-ray $100 per visit

Not covered

Pre-authorization is required for Imaging (CT/PET/MRI).
Imaging (CT / PET scans, MRIs)

20%

Not covered

Pre-authorization is required for Imaging (CT/PET/MRI).
If you need drugs to treat
your illness or condition.
More information about
prescription drug coverage
is available at
www.brighthealthplan.com
Generic drugs (Tier 2)

$15

Not coveredTier 1 drugs are Preventive medications that are of $0 cost to you. Copays shown reflect the cost per retail prescription for a 30-day supply. Mail Order copays are 2.5 times the Retail cost for a 90-day supply
Preferred brand drugs (Tier 3)

$50

Not covered
Non-preferred brand drugs
(Tier 4)

$125

Not covered

Specialty drugs (Tier5)

20%

Not covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

20%

Not covered

Services require pre-authorization.
Physician/surgeon fees

20%

Not covered

If you need immediate
medical attention
Emergency room care

$500

$500

None
Emergency medical transportation

20%

20%

None
Urgent care

$50

$50

None
If you have a hospital
stay
Facility fee (e.g., hospital room)

20%

Not covered

Services require pre-authorization.
Physician/surgeon fee

20%

Not covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services$20

Not covered

None
Inpatient services

20%

Not covered

Services require pre-authorization.
If you are pregnantOffice visits

No charge

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
Childbirth/delivery professional services

20%

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
Childbirth/delivery facility
services

20%

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
If you need help
recovering or have other special health needs
Home health care

20%

Not covered

Services require pre-authorization
Rehabilitation services

20%

Not covered

Habilitation services

20%

Not covered

Skilled nursing care

20%

Not covered

Durable medical equipment

20%

Not covered

Services require pre-authorization.
Hospice service20%

Not covered

Services require pre-authorization.
If your child needs
dental or eye care
Children’s eye exam

No Charge

Not covered

Limited to 1 eye exam per calendar year through the end of the month in which the dependent child turns19.
Children’s glasses

No Charge

Not covered

Limited to 1 pair of glasses including standard frames and standard lenses, or a one-year supply of contact lenses through the end of the month in which the dependent child turns 19.
Children’s dental check-up

No Charge

Not Covered

Includes diagnostic and preventive services for dependent children through the end of the month in which the dependent child turns 19. Refer to the policy for covered services and limitations.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Cosmetic Surgery
  • Dental care (Adults)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adults)
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care
  • Hearing aids
  • Infertility treatment
  • Private-duty nursing
  • Routine foot care (for diabetes)