Bright Advantage Flex plan details in Ohio

Choosing a Bright Advantage Flex plan in in Ohio gives our members added flexibility with out-of-network (OON) coverage. A $0 monthly premium comes with no referrals needed in-network, preventive dental, and vision coverage. Explore all the benefits below.

Bright Advantage Flex (PPO)

Monthly Plan Premium

$0*

Your Selected Plan Add-ons

$0*

Total Monthly Premium

$0*

Plan Details

Monthly Plan Premium

$0

Annual Medical Deductible

$0

Annual Prescription Drug Deductible

$0

Primary Care Visit

$0 copay

Specialist Visit

$35 copay

Preventive Care

$0 copay

Annual Physical

$0 copay

Annual Max Out-Of-Pocket

$4,600

Coinsurance For Most OON Services

45%

Combined Annual Max Out-of-pocket

$10,000

Emergency Care

$90 copay

Urgent Care

$35 copay

Outpatient Surgery

$195 copay

Diagnostic Radiology Services

20% copay

Lab Services

$10 copay

Outpatient X-rays

$15 copay

Hospitalization

$285/day for days 1-5

$0/day for days 6-90

$0/day for days 90+

Outpatient Surgery (Ambulatory)

$285 copay

Prescription Drug Coverage Details

Annual Prescription Drug Deductible

$0

Costs For Initial Coverage Period

Tier

Retail pricing (30 or 90 day supply)

Mail order pricing (90 day supply)

Tier 1: Preferred Generic

Retail pricing (30 or 90 day supply)

$4

Mail order pricing (90 day supply)

$8

Tier 2: Generic

Retail pricing (30 or 90 day supply)

$15

Mail order pricing (90 day supply)

$30

Tier 3: Preferred Brand

Retail pricing (30 or 90 day supply)

$42

Mail order pricing (90 day supply)

$126

Tier 4: Non-Preferred Drug

Retail pricing (30 or 90 day supply)

$95

Mail order pricing (90 day supply)

$285

Tier 5: Specialty Tier

Retail pricing (30 or 90 day supply)

33%

Mail order pricing (90 day supply)

33%

Coverage Gap

After your total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,820, you will enter the coverage gap (also called the "donut hole"). This means that there's a temporary change in what you will pay for your drugs. Not everyone will enter the coverage gap. If you enter the coverage gap, you'll pay 25% of the plan's cost for covered brand name drugs and 37% of the plan's cost for covered generic drugs until your costs total $5,100, which is the end of the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,100, you will pay the greater of:

  • 5% of the cost, or
  • a $3.40 copay for a generic drug or a drug that’s treated like a generic and a $8.50 copay for all other drugs

Bright Extra Benefits

Preventive Dental

Copay for X-rays

$0

Copay for oral exam

$0

Copay for cleaning

$0

Copay for fluoride treatment

$0

Want more coverage? Upgrade to enhanced dental coverage

• Copays vary depending on services you receive

$18/month

Hearing Services

Routine Hearing Exam & Hearing Aid Fitting/Evaluation

$0

Hearing Aid Allowance

$1,000 every three years

Preventive Vision

Routine Eye Exam

$0

Want more coverage? Upgrade to Comprehensive Vision

• $130 materials allowance every two years

$4/month

Included Extra Benefits

Fitness

Additional Plan Resources

Summary of Benefits

Enrollment Form

Evidence of Coverage (EOC)

LIS Premium Summary Chart

If you qualify for Extra Help, you may be eligible for discounted monthly premiums. Learn more about Bright Health plans with Extra Help

Still have questions?
We'd love to hear from you!

Last Updated: Fri Nov 23 2018

Y0127_MA-WEB-3057_M

Bright Health plans are HMOs and PPOs with a Medicare contract. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Enrollment in our plans depends on contract renewal.

This information is not a complete description of benefits. Call 844-667-5502 | TTY:711 for more information.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov 

Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.

Other providers are available in our network. Most network providers participate through our Care Partner.

Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.

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