Lowest-priced health savings account qualified plan offered through HealthSource RI. A Bronze plan that offers high-quality health coverage, our full network of doctors, and top-notch customer service. Preventive services are covered at 100%.
View Cost-Sharing
Deductible: $6,000 (Individual) / $12,000 (Family)
Out of Pocket Max: $6,550 (Individual) / $13,100 (Family)
Primary Care/Behavioral Health Office Visits: Only deductible applies
Specialist/Urgent Care Visits: Only deductible applies
Inpatient/Imaging/Lab Services: Only deductible applies
Pharmacy (Tiers 1-6): $5*/$10*/$35*/$50*/30%*/30%*
*after deductible
What do you need help with today?
- I need a doctor.
- I want to know if my medicine is covered.
- I want to know my rights and privacy.
- I want to access my Pharmacy Member Portal.
- Use this portal to check your medications, sign up for mail order pharmacy and review drug costs
- I want to access my Behavioral Health Member Portal.
Where can I learn about my benefits?
- Price Information for Your Medical Benefits [PDF, 301KB]
- Price Information for Your Pharmacy Benefits
- Plan Summary [PDF, 1209KB]
- Certificate of Coverage [PDF, 1,490KB]
- Pediatric Dental Benefits
- Summary of Benefits and Coverage
- 10004-01 ECONOMY[PDF, 474KB]
- 10004-02 ECONOMY (ZeroCS) [PDF, 472KB]
- 10004-03 ECONOMY (LimitedCS) [PDF, 474KB]
- Glossary of Health Coverage and Medical Terms [PDF, 139KB]
Read the latest issue of our quarterly member newsletter, Healthy You.
Questions about ECONOMY? We’re happy to help.
Call us today at 1-855-321-9244.