Friday Bronze Plus

91538OK0010011
Expanded Bronze
HMO

Friday Bronze Plus is an Expanded Bronze HMO plan by Friday Health Plans.

IMPORTANT: You are viewing the 2023 version of Friday Bronze Plus 91538OK0010011. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Friday Bronze Plus is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Friday Bronze Plus 91538OK0010011.
Insurer: Friday Health Plans
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 91538OK0010011

Cost-Sharing Overview

Friday Bronze Plus offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Friday Bronze Plus?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Friday Bronze Plus offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Diabetes
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Friday Bronze Plus covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Urgent and Emergent only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Urgent and Emergent only
National Network: No

Additional Benefits and Cost-Sharing

Friday Bronze Plus includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
No Charge 100.00%
Specialist Visit
Covered
No Charge after deductible 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
No Charge 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
No Charge after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
No Charge after deductible 100.00%
Hospice Services
Covered
No Charge after deductible 100.00%
Routine Dental Services (Adult)
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Covered
No Charge after deductible 100.00%85 Visit(s) per Benefit Period Pre-authorization required.
Routine Eye Exam (Adult)
Urgent Care Centers or Facilities
Covered
$75.00 $75.00
Home Health Care Services
Covered
No Charge after deductible 100.00%30 Visit(s) per Benefit Period
Emergency Room Services
Covered
No Charge after deductible No Charge after deductible
Emergency Transportation/Ambulance
Covered
No Charge after deductible No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
No Charge after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
No Charge after deductible 100.00%
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
No Charge after deductible 100.00%30 Days per Benefit Period
Prenatal and Postnatal Care
Covered
No Charge after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
No Charge 100.00% Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible 100.00% Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Substance Abuse Disorder Outpatient Services
Covered
No Charge 100.00% Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible 100.00% Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Generic Drugs
Covered
$25.00 100.00% Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs.
Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs. Insulin will not exceed $30 for a 30-day supply and $90 for a 90-day supply.
Non-Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs.
Specialty Drugs
Covered
No Charge after deductible 100.00% Up to 30-day supply Retail only.
Outpatient Rehabilitation Services
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Maximum of 30 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).
Habilitation Services
Covered
No Charge after deductible 100.00%30 Visit(s) per Year
Chiropractic Care
Covered
No Charge after deductible 100.00% Prior authorization after 30 visits
Durable Medical Equipment
Covered
No Charge after deductible 100.00% Only Durable Medical Equipment considered standard and/or basic as defined by nationally recognized guidelines are covered.
Hearing Aids
Covered
No Charge after deductible 100.00% One hearing aid per ear every 48 months.
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%
Routine Foot Care
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Exam(s) per Year
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year
Dental Check-Up for Children
Not Covered
2 Visit(s) per Year
Rehabilitative Speech Therapy
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Maximum of 30 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Maximum of 30 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
No Charge after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
No Charge after deductible 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Transplant
Covered
No Charge after deductible 100.00%
Accidental Dental
Covered
No Charge after deductible 100.00%
Dialysis
Covered
No Charge after deductible 100.00%
Allergy Testing
Covered
No Charge after deductible 100.00% Issuer clarifies this is a covered benefit but stipulated under the Medical Policy and not written in the member materials.
Chemotherapy
Covered
No Charge after deductible 100.00%
Radiation
Covered
No Charge after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00%
Prosthetic Devices
Covered
No Charge after deductible 100.00%
Infusion Therapy
Covered
No Charge after deductible 100.00%25 Visit(s) per Benefit Period Covered under Outpatient Therapy Services.
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Covered
No Charge after deductible 100.00% Diabetes self-management training and training related to medical nutrition therapy.
Reconstructive Surgery
Covered
No Charge after deductible 100.00% Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.
Gender Affirming Care
Covered
No Charge after deductible 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following Friday Bronze Plus preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Friday Bronze Plus including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Friday Bronze Plus?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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