Plan Brochure
2022 Plan Comparison
2022 Drug Formulary
$0 Rx List (including contraceptives)
Provider Directory
Overview
The Bright Health Catastrophic Plan has the lowest premiums of all the plans. This plan is best for those under the age of 30 who desire low premiums and expect minimal medical incidents. Coverage includes 3 primary care visits, then no other benefits until the maximum out-of-pocket ($8,550 individual / $17,100 family) is reached.
- Catastrophic 3 $0 PCP Visits – $8,550 individual deductible and 0% coinsurance.
Bright Health Catastrophic 3 $0 PCP Visits
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 ? | $8,550 Individual or $17,100 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? | No. You will have to meet the deductible before the plan pays for any services. | 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? |
No | You 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? |
No | You can see the specialist you choose without a referral. |
Common Medical Event
Services 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 clinic
Primary care visit to treat an injury or illness
$0 first 3 visits, then 0% after deductible
Not covered
None
Specialist visit
0%
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 test
Diagnostic test (x-ray, blood work)
Labs: 0%X-rays: 0%
Not covered
Services require pre-authorization.
Imaging (CT / PET scans, MRIs)
0%
Not covered
Services require pre-authorization.
If you need drugs to treat
your illness or condition.
More information about
prescription drug coverage
is available at
www.brighthealthplan.com
your illness or condition.
More information about
prescription drug coverage
is available at
www.brighthealthplan.com
Generic drugs (Tier 2)
0%
Not covered
Tier 1 drugs are Preventive medications that are of $0 cost to you. Copays shown reflect the cost per retail prescription. Mail Order copays are 2.5 times the Retail cost.
Preferred brand drugs (Tier 3)
0%
Not covered
Non-preferred brand drugs
(Tier 4)
(Tier 4)
0%
Not covered
Specialty drugs (Tier5)
0%
Not covered
If you have outpatient
surgery
surgery
Facility fee (e.g., ambulatory surgery center)
0%
Not covered
Services require pre-authorization.
Physician/surgeon fees
0%
Not covered
If you need immediate
medical attention
medical attention
Emergency room care
0%
0%
None
Emergency medical transportation
0%
0%
None
Urgent care
0%
0%
None
If you have a hospital
stay
stay
Facility fee (e.g., hospital room)
0%
Not covered
Services require pre-authorization.
Physician/surgeon fee
0%
Not covered
If you have mental
health, behavioral
health, or substance
abuse needs
health, behavioral
health, or substance
abuse needs
Outpatient services
0%
Not covered
None
Inpatient services
0%
Not covered
Services require pre-authorization.
If you are pregnant
Office 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
0%
Not covered
Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
Childbirth/delivery facility
services
services
0%
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
recovering or have other special health needs
Home health care
0%
Not covered
Services require pre-authorization. Limited to 20 visits per calendar year. Services require pre-authorization. Limited to 35 combined visits per year for Occupational Therapy, Physical Therapy, Speech Therapy, and Chiropractic
Manipulations. Limited to 60 days per calendar year.
Services require pre-authorization.
Manipulations. Limited to 60 days per calendar year.
Services require pre-authorization.
Rehabilitation services
0%
Not covered
Habilitation services
0%
Not covered
Skilled nursing care
0%
Not covered
Durable medical equipment
0%
Not covered
Services require pre-authorization.
Hospice service
0%
Not covered
Services require pre-authorization.
If your child needs
dental or eye care
dental or eye care
Children’s eye exam
0%
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
0%
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
0%
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.)
- Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
- Acupuncture
- Dental care (Adults)
- Hearing aids
- Infertility treatment
- Non-emergency care when traveling outside the U.S.
- Private-duty nursing
- Routine eye care (Adults)
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
- Chiropractic care
- Routine foot care (for diabetes)