UCare Minnesota - UCare M Health Fairview Bronze HSA
Yearly Deductible
Out-of-Pocket Maximum
Primary Care Visit
No Charge after deductible
50% Coinsurance after deductible
Specialist Visit
No Charge after deductible
50% Coinsurance after deductible
Other Practitioner Office Visit
No Charge after deductible
50% Coinsurance after deductible
Preventive Care/Screening/Immunization
No Charge
50% Coinsurance after deductible
X-rays and Diagnostic Imaging
No Charge after deductible
50% Coinsurance after deductible
Imaging (CT/PET scans, MRIs)
No Charge after deductible
50% Coinsurance after deductible
Generic Drugs
No Charge after deductible
100% Coinsurance
Preferred Brand Drugs
No Charge after deductible
100% Coinsurance
Non-Preferred Brand Drugs
No Charge after deductible
100% Coinsurance
Specialty Drugs
No Charge after deductible
100% Coinsurance
Outpatient Services
No Charge after deductible
50% Coinsurance after deductible
Emergency Room
No Charge after deductible
No Charge after deductible
Ambulance Services
No Charge after deductible
No Charge after deductible
Urgent Care Services
No Charge after deductible
50% Coinsurance after deductible
Inpatient Hospital Services
No Charge after deductible
50% Coinsurance after deductible
Inpatient Physician and Surgical Services
No Charge after deductible
50% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
No Charge after deductible
50% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
No Charge after deductible
50% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services
No Charge after deductible
50% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
No Charge after deductible
50% Coinsurance after deductible
Prenatal and Postnatal Care
No Charge
50% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
No Charge after deductible
50% Coinsurance after deductible
Home Healthcare Services
No Charge after deductible
50% Coinsurance after deductible
Outpatient Rehabilitation Services
No Charge after deductible
50% Coinsurance after deductible
Habilitation Services
No Charge after deductible
50% Coinsurance after deductible
Skilled Nursing Facility
No Charge after deductible
50% Coinsurance after deductible
Durable Medical Equipment
No Charge after deductible
50% Coinsurance after deductible
Hospice Services
No Charge after deductible
50% Coinsurance after deductible
Acupuncture
Not covered
Not covered
Rehabilitative Occupational and Rehabilitative Physical Therapy
No Charge after deductible
50% Coinsurance after deductible
Well Baby Visits and Care
No Charge
50% Coinsurance after deductible
Allergy Testing
No Charge after deductible
50% Coinsurance after deductible
Diabetes Education
No Charge
50% Coinsurance after deductible
Nutritional Counseling
No Charge
50% Coinsurance after deductible
Eye Exam for Children
No Charge
50% Coinsurance after deductible
Eyeglasses for Children
No Charge after deductible
100% Coinsurance
Hearing Aids for Children
No Charge after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not covered
Not covered
Basic Dental (Child)
No Charge after deductible
100% Coinsurance
Dental Checkup (Child)
No Charge
50% Coinsurance after deductible
Major Dental Care (Adult)
Not covered
Not covered
Major Dental Care (Child)
No Charge after deductible
100% Coinsurance