Back to Rate Plans
SimplyBlue Plus Bronze 4
TJF6
Bronze
HSA Eligible
Premium Rates
Single
$767.47
Subscriber & Spouse
$1,534.94
Subscriber & Child(ren)
$1,304.70
Family
$2,187.29
Plan Information
Plan Type
Deductible HSA
Metal Level
Bronze
Effective Date
01/01/2026 - 03/31/2026
Rating Region
Rochester
Deductibles (In-Network)
Individual
$8,500
Family
$17,000
Deductibles (Out-of-Network)
Individual
$10,000
Family
$20,000
Out of Pocket Max (In-Network)
Individual
$8,500
Family
$17,000
Out of Pocket Max (Out-of-Network)
Individual
$10,000
Family
$20,000
Copays & Coinsurance
PCP Office Visit
100% subject to deductible
Specialist Office Visit
100% subject to deductible
ER Copay
100% subject to deductible
Urgent Care Copay
100% subject to deductible
Coinsurance (In-Network)
100%
Coinsurance (Out-of-Network)
100%
Prescription Drug Coverage
100% subject to deductible