Individual and Family Plans
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Jefferson Health Plans offers Individual & Family Plans with $0 medical deductibles, low-cost prescription drug coverage, 24/7 virtual visits, and more. Use the tool below to compare plans.
- Enhanced Tier
- Standard Tier
Compare Plans & Benefits
Compare up to three plans at a time.
Jefferson Health Plans offers Individual and Family Plans with $0 medical deductibles, low-cost generic prescription drug coverage, and no referral requirements. Review the chart below to learn more.*
| Plan Name: | $0 Deductible + Bronze | Total + Bronze | $0 Deductible + Silver | Balanced + Silver | Total + Silver | $0 Deductible + Gold | Total + Gold | |
|---|---|---|---|---|---|---|---|---|
| Medical Deductible - Individual/Family | $0/$0 | $7,900/$15,800 | $0/$0 | $2,400/$4,800 | $4,900/$9,800 | $0/$0 | ||
| Drug Deductible | $5,000/$10,000 | Combined | $5,000/$10,000 | $500/$1,000 | $600/$1,200 | Combined | $1,000/$2,000 | |
| Out-of-Pocket Maximum - Individual/Family | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | |
| No Cost Share PCP Visit | 1/Benefit Year | 1/Benefit Year | 2/Benefit Year | 2/Benefit Year | 2/Benefit Year | 2/Benefit Year | 2/Benefit Year | |
| PCP Visit | $55 No Deductible | $45 No Deductible | $45 No Deductible | $45 No Deductible | $35 No Deductible | $25 No Deductible | $20 No Deductible | |
| Specialist Visit | $100 No Deductible | $95 No Deductible | $95 No Deductible | $95 No Deductible | $85 No Deductible | $70 No Deductible | $65 No Deductible | |
| Virtual Care (JeffConnect) | No Charge | No Charge | No Charge | No Charge | No Charge | No Charge | No Charge | |
| Virtual Care - Primary Care Visit | $55 No Deductible | $45 No Deductible | $45 No Deductible | $45 No Deductible | $35 No Deductible | $25 No Deductible | $20 No Deductible | |
| Virtual Care - Specialist Visit | $100 No Deductible | $95 No Deductible | $95 No Deductible | $95 No Deductible | $85 No Deductible | $70 No Deductible | $65 No Deductible | |
| Acute Stays | $1,800 Per Day After Deductible (Max 5 copays per admit) | $650 Per Day After Deductible (Max 5 copays per admit) | $595 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $450 Per Day After Deductible (Max 5 copays per admit) | $350 Per Day After Deductible (Max 5 copays per admit) | ||
| Mental/Behavioral Health/SUD | $1,800 Per Day After Deductible (Max 5 copays per admit) | $650 Per Day After Deductible (Max 5 copays per admit) | $595 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $450 Per Day After Deductible (Max 5 copays per admit) | $350 Per Day After Deductible (Max 5 copays per admit) | $300 Per Day After Deductible (Max 5 copays per admit) | |
| Delivery and All Inpatient Services for Maternity Care | $1,800 Per Day After Deductible (Max 5 copays per admit) | $650 Per Day After Deductible (Max 5 copays per admit) | $595 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $450 Per Day After Deductible (Max 5 copays per admit) | $350 Per Day After Deductible (Max 5 copays per admit) | $300 Per Day After Deductible (Max 5 copays per admit) | |
| Durable Medical Equipment | 50% Coinsurance After Deductible | 50% Coinsurance After Deductible | 40% Coinsurance After Deductible | 40% Coinsurance After Deductible | 40% Coinsurance After Deductible | 50% Coinsurance After Deductible | 50% Coinsurance After Deductible | |
| Emergency Room Services | $1,200 No Deductible | 50% Coinsurance After Deductible | $975 No Deductible | $950 No Deductible | $950 No Deductible | $450 No Deductible | $400 No Deductible | |
| Imaging (CT/PET Scans, MRIs) | $250 No Deductible | $250 No Deductible | $150 No Deductible | $150 No Deductible | $150 No Deductible | $80 No Deductible | $100 No Deductible | |
| Occupational and Rehabilative Physical Therapy (30 visits combined per year) | $150 No Deductible | $150 No Deductible | $100 No Deductible | $100 No Deductible | $100 No Deductible | $70 No Deductible | $65 No Deductible | |
| Urgent Care Centers or Facilities | $100 No Deductible | $95 No Deductible | $95 No Deductible | $95 No Deductible | $85 No Deductible | $70 No Deductible | $65 No Deductible | |
| Pharmacy Services | Preventative Drugs: No Charge Generic Drugs Tier 1: $35 No Deductible Generic Drugs Tier 2: $35 No Deductible Preferred Brand Drugs: $200 No Deductible Non-Preferred Brand Drugs: $250 Copay After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $30 No Deductible Generic Drugs Tier 2: $30 No Deductible Preferred Brand Drugs: $150 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: 50% Coinsurance After Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: 50% Coinsurance After Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $0 No Deductible Generic Drugs Tier 2: $10 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: Coinsurance After Deductible |
Compare Plans & Benefits
Compare up to three plans at a time.
Jefferson Health Plans offers Individual and Family Plans with $0 medical deductibles, low-cost generic prescription drug coverage, and no referral requirements. Review the chart below to learn more.*
| Plan Name: | $0 Deductible + Bronze | Total + Bronze | $0 Deductible + Silver | Balanced + Silver | Total + Silver | $0 Deductible + Gold | Total + Gold | |
|---|---|---|---|---|---|---|---|---|
| Medical Deductible - Individual/Family | $2,000/$4,000 | $9,450/$18,900 | $2,000/$4,000 | $6,900/$13,800 | $8,000/$16,000 | $500/$1,000 | $1,000/$2,000 | |
| Drug Deductible | $5,000/$10,000 | Combined | $5,000/$10,000 | $500/$1,000 | $600/$1,200 | Combined | $1,000/$2,000 | |
| Out-of-Pocket Maximum - Individual/Family | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | $9,450/$18,900 | |
| No Cost Share PCP Visit | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| PCP Visit | $100 No Deductible | $95 No Deductible | $100 No Deductible | $95 No Deductible | $90 No Deductible | $60 No Deductible | $60 No Deductible | |
| Specialist Visit | $150 No Deductible | $150 No Deductible | $130 No Deductible | $130 No Deductible | $125 No Deductible | $100 No Deductible | $100 No Deductible | |
| Virtual Care (JeffConnect) | N/A | No Charge | N/A | N/A | N/A | N/A | N/A | |
| Virtual Care - Primary Care Visit | $100 No Deductible | $95 No Deductible | $100 No Deductible | $95 No Deductible | $90 No Deductible | $60 No Deductible | $60 No Deductible | |
| Virtual Care - Specialist Visit | $150 No Deductible | $150 No Deductible | $130 No Deductible | $130 No Deductible | $125 No Deductible | $100 No Deductible | $100 No Deductible | |
| Acute Stays | $3,000 Per Day After Deductible (Max 5 copays per admit) | $900 Per Day After Deductible (Max 5 copays per admit) | $1,200 Per Day After Deductible (Max 5 copays per admit) | $850 Per Day After Deductible (Max 5 copays per admit) | $800 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $500 Per Day After Deductible (Max 5 copays per admit) | |
| Mental/Behavioral Health/SUD | $1,800 Per Day After Deductible (Max 5 copays per admit) | $650 Per Day After Deductible (Max 5 copays per admit) | $595 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $450 Per Day After Deductible (Max 5 copays per admit) | $350 Per Day After Deductible (Max 5 copays per admit) | $300 Per Day After Deductible (Max 5 copays per admit) | |
| Delivery and All Inpatient Services for Maternity Care | $3,000 Per Day After Deductible (Max 5 copays per admit) | $900 Per Day After Deductible (Max 5 copays per admit) | $1,200 Per Day After Deductible (Max 5 copays per admit) | $850 Per Day After Deductible (Max 5 copays per admit) | $800 Per Day After Deductible (Max 5 copays per admit) | $550 Per Day After Deductible (Max 5 copays per admit) | $500 Per Day After Deductible (Max 5 copays per admit) | |
| Durable Medical Equipment | 50% Coinsurance After Deductible | 50% Coinsurance After Deductible | 40% Coinsurance After Deductible | 40% Coinsurance After Deductible | 40% Coinsurance After Deductible | 50% Coinsurance After Deductible | 50% Coinsurance After Deductible | |
| Emergency Room Services | $1,200 No Deductible | 50% Coinsurance After Deductible | $975 No Deductible | $950 No Deductible | $950 No Deductible | $450 No Deductible | $400 No Deductible | |
| Imaging (CT/PET Scans, MRIs) | $250 No Deductible | $250 No Deductible | $150 No Deductible | $150 No Deductible | $150 No Deductible | $80 No Deductible | $100 No Deductible | |
| Occupational and Rehabilative Physical Therapy (30 visits combined per year) | $200 No Deductible | $150 No Deductible | $100 No Deductible | $100 No Deductible | $100 No Deductible | $70 No Deductible | $75 No Deductible | |
| Urgent Care Centers or Facilities | $150 No Deductible | $150 No Deductible | $130 No Deductible | $130 No Deductible | $125 No Deductible | $100 No Deductible | $100 No Deductible | |
| Pharmacy Services | Preventative Drugs: No Charge Generic Drugs Tier 1: $35 No Deductible Generic Drugs Tier 2: $35 No Deductible Preferred Brand Drugs: $200 No Deductible Non-Preferred Brand Drugs: $250 Copay After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $30 No Deductible Generic Drugs Tier 2: $30 No Deductible Preferred Brand Drugs: $150 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: 50% Coinsurance After Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: 50% Coinsurance After Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $5 No Deductible Generic Drugs Tier 2: $20 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: 50% Coinsurance After Deductible | Preventative Drugs: No Charge Generic Drugs Tier 1: $0 No Deductible Generic Drugs Tier 2: $10 No Deductible Preferred Brand Drugs: $100 No Deductible Non-Preferred Brand Drugs: 50% Coinsurance After Deductible Specialty Drugs: Coinsurance After Deductible |
