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SimplyBlue Plus Bronze 7
TKI4
Bronze
Not HSA Eligible
Premium Rates
Single
$685.81
Subscriber & Spouse
$1,371.61
Subscriber & Child(ren)
$1,165.87
Family
$1,954.55
Plan Information
Plan Type
Deductible
Metal Level
Bronze
Effective Date
01/01/2026 - 03/31/2026
Rating Region
Rochester
Deductibles (In-Network)
Individual
$10,600
Family
$21,200
Deductibles (Out-of-Network)
Individual
$10,600
Family
$21,200
Out of Pocket Max (In-Network)
Individual
$10,600
Family
$21,200
Out of Pocket Max (Out-of-Network)
Individual
$10,600
Family
$21,200
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