Network Health

Plan Overviews

Ambetter from Superior HealthPlan provides quality healthcare solutions that help residents of Wisconsin live better. With a variety of affordable coverage options, they make it easier to stay healthy.

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  Prestige Bronze Essential Prestige Bronze Standard Prestige Bronze 20 HDHP
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 40% 50% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

(Individual/Family)

$5,500/$11,000 $6,650/$13,300 $5,500/$11,000
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $7,150/$14,300 $6,550/$13,100
Preventative Care $0 $0 $0
Virtual Visit $20 $35 20% after deductible
Primary Care Doctor Visit $30 after deductible

First 3 visits – $45

Then 50% after deductible

20% after deductible
Specialist Visit $80 after deductible 50% after deductible 20% after deductible
Hospital Stay 40% after deductible 50% after deductible 20% after deductible
Maternity Care 40% after deductible 50% after deductible 20% after deductible
Emergency Room $400 after deductible 50% after deductible 20% after deductible
X-ray, Lab and Pathology $75 after deductible 50% after deductible 20% after deductible
Ambulance 40% after deductible 50% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests $75 after deductible  50% after deductible 20% after deductible
Chiropractic 40% after deductible 50% after deductible 20% after deductible
Urgent Care $75 after deductible 50% after deductible 20% after deductible
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill

 

  Prestige Silver Essential Prestige Silver 0 Prestige Silver Standard Prestige Silver 20 HDHP
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30% No charge after deductible 20% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

(Individual/Family)

$2,500/$5,000 $4,000/$8,000 $3,500/$7,000 $2,600/$5,200
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $7,150/$14,300 $7,150/$14,300 $6,550/$13,100
Preventative Care $0
Virtual Visit $10 per visit No charge after deductible $20 per visit 20% after deductible
Primary Care Doctor Visit $20 per visit

No charge after deductible

$65 per visit 20% after deductible
Specialist Visit $55 per visit No charge after deductible $65 per visit 20% after deductible
Hospital Stay 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Maternity Care 40% after deductible No charge after deductible 20% after deductible 20% after deductible
Emergency Room $350 No charge after deductible $400 after deductible 20% after deductible
X-ray, Lab and Pathology $55 per service No charge after deductible 20% after deductible 20% after deductible
Ambulance $250 per trip No charge after deductible 20% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Chiropractic 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Urgent Care $75  No charge after deductible $75 20% after deductible
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill

 

  Prestige Gold Essential Prestige Gold Standard
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 20% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

(Individual/Family)

$500/$1,000 $1,250/$2,500
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $4,750/$9,500
Preventative Care $0 $0
Virtual Visit $5 per visit $10 per visit
Primary Care Doctor Visit $15 per visit

$20 per visit

Specialist Visit $35 per visit $50 per visit
Hospital Stay 20% after deductible 20% after deductible
Maternity Care 20% after deductible 20% after deductible
Emergency Room $250 $250 after deductible
X-ray, Lab and Pathology $35 per service 20% after deductible
Ambulance 20% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests $35 per service 20% after deductible
Chiropractic 20% after deductible 20% after deductible
Urgent Care $50 $65
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill

 

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Network Health Wisconsin Coverage Map

 

 

Contact Us

New Enrollments

Phone: (312) 726-6565
Email: [email protected]

 

Mailing Address

Network Health
1570 Midway Place
Menasha, WI 54952
800-826-0940 or 920-720-1300

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