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Tufts Health Direct Bronze


Tufts Health Direct Bronze offers comprehensive health care coverage with its own annual deductible and
out-of-pocket maximum, and its own cost sharing for covered services.

Learn more about Tufts Health Direct cost-sharing terms.

Key highlights:

  • Has an annual integrated deductible and out-of-pocket maximum
  • High out-of-pocket expenses

Tufts Health Direct Bronze

Annual deductible (individual/family)

MedicalClick for Definition

$2,000/$4,000

PharmacyClick for Definition

Integrated with medical deductible

Annual out-of-pocket maximum (individual/family)

MedicalClick for Definition

$6,350/$12,700

PharmacyClick for Definition

Integrated with medical out-of-pocket maximum


Costs for covered services

Covered service

Co-paymentsClick for Definition and co-insuranceClick for Definition

Outpatient Medical Care
(Hospital or clinic treatment that does not require an overnight stay)

Community health center visits:

  • Primary care provider (PCP)
  • Specialist



$50 co-payment*

$75 co-payment*

Office visits:

  • PCP
  • Specialist



$50 co-payment*

$75 co-payment*

Outpatient surgery (hospital/ambulatory surgery centers)

$1,000 co-payment*

X-ray/labs

$75 co-payment*

High-cost imaging (MRI, CAT, and PET)

$1,000 co-payment*

Abortion services

$1,000 co-payment*

Inpatient Medical Care
(Hospital or clinic treatment that requires at least one overnight stay)

Room and board (includes deliveries/surgery/X-rays/labs)

$1,000 co-payment*

Prescription Drugs

Medication via pharmacy (1-month supply):

  • Generic
  • Preferred
  • Nonpreferred



$30 co-payment*

50% co-insurance*

50% co-insurance*

Medication via mail order (90-day supply):

  • Generic
  • Preferred
  • Nonpreferred



$60 co-payment*

50% co-insurance*

50% co-insurance*

Emergency Care

Emergency care

$750 co-payment*

Inpatient Mental Health and/or Substance Abuse
(Hospital or clinic treatment that requires at least one overnight stay)

Mental health and/or substance abuse services

$1,000 co-payment*

Outpatient Mental Health and/or Substance Abuse
(Hospital or clinic treatment that does not require an overnight stay)

Mental health and/or substance abuse services:

  • Methadone-related services (dosing, counseling, labs)
  • Applied behavioral analysis
  • Autism treatment

$50 co-payment*

Rehabilitation Services

Cardiac rehabilitation

$75 co-payment*

Home health care

No co-payment

Extended inpatient care (100 total days per benefit year):

  • Inpatient care in a skilled nursing facility
  • Inpatient care in a rehabilitation or chronic-disease hospital

$1,000 co-payment*

Short-term outpatient rehabilitation (physical, occupational, and speech therapies)

$75 co-payment*

Other Benefits

Ambulance

No co-payment

Breastfeeding services

No co-payment

Chiropractic care

$75 co-payment*

Cleft palate/cleft lip care

Depends on place of service

Dental emergency care/oral surgery

$750 co-payment*

Durable medical equipment/supplies/hearing aids/orthotics/prosthetics/oxygen and respiratory therapy equipment

20% co-insurance

Hospice

No co-payment

Infertility services

Depends on place of service

Podiatry

$75 co-payment*

Qualified clinical trials

Depends on place of service

Routine vision (exam every 12 months for diabetics, 24 months for nondiabetics; up to $80 for basic frames/lenses every 24 months)

No co-payment

Wellness (preventive visits/contraceptives/family planning/nutrition)

No co-payment

* After deductible

Limits and exclusions may apply.
American Indians and Alaskan Natives do not need to pay co-payments or co-insurance for services received through the Indian Health Service.

For more information, check our Tufts Health Direct Bronze Summary of Benefits and Coverage (PDF).

For a complete list of services, check our Tufts Health Direct Member Handbook (PDF).

Learn more about Tufts Health Direct benefits.

Learn how to apply.

Questions?
Call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.

888-257-1985
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