Affordably priced Bronze plan offered through HealthSource RI. This plan has a copay for PCP visits and behavioral health outpatient visits. Preventive services are covered at 100%.
View Cost-Sharing
Deductible: $6,550 (Individual) / $13,100 (Family)
Out of Pocket Max: $7,350 (Individual) / $14,700 (Family)
Primary Care/Behavioral Health Office Visits: $20
Specialist/Urgent Care Visits: 30% co-insurance*
Inpatient/Imaging/Lab Services: 30% co-insurance*
Pharmacy (Tiers 1-6): $10*/$15*/$40*/$55*/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, 2076KB]
- Pediatric Dental Benefits
- Summary of Benefits and Coverage:
- 10006-01 INNOVATION [PDF, 472KB]
- 10006-02 INNOVATION (ZeroCS) [PDF, 472KB]
- 10006-03 INNOVATION (LimitedCS) {PDF 476KB
- Glossary of Health Coverage and Medical Terms [PDF, 139KB]
Read the latest issue of our quarterly member newsletter, Healthy You.