Brown Health Medical Plan
Here’s a quick look at your benefits. You can find a more thorough description of benefits in the Summary of Benefits and Coverage for Brown Health Medical Plan.
New additions to Tier 1
Some hospitals and physician groups are now considered to be part of the Brown Health Preferred Network (Tier 1), even though they may not appear that way on the Find Care tool. The new additions to the Brown Health Preferred Network are: Saint Anne’s Hospital and Physicians, Morton Hospital and Physicians, Hawthorn Medical Associates, Brown Health Medical Group of Massachusetts, Prima CARE, Hawthorn Urgent Care, Pediatric Associates at Northwoods, Middleboro Pediatrics, Pediatric Associates of Fall River, Prima Care Walk In, Quest Diagnostics MA, and Steward Medical Group/Revere.
Brown University Health does have additional providers that are considered Tier 1 that may not be on this list. If you do have any questions regarding your physician’s tiering, please reach out to the CARE Team at (401) 429-2102 or 1-866-987-3706.
Coverage | Preferred Network1 | National Blue Cross Network | Out-of-Network |
|---|---|---|---|
Deductible2 | Individual: $250 | Individual: $1,000 | Individual: $3,000 |
Out-of-Pocket Maximum2 | Individual: $4,000 | Individual: $4,000 | Individual: $9,450 |
Preventive Care | Covered in full | Covered in full | 30% coinsurance after deductible |
Primary Care | $20 copay after deductible | $40 copay after deductible | 30% coinsurance after deductible |
Specialist | $30 copay after deductible | $60 copay after deductible | 30% coinsurance after deductible |
Physical/ Occupational/ Speech Therapy | Covered in full after deductible | $40 copay after deductible | 30% coinsurance after deductible |
Inpatient Hospital Care and Surgery | $300 after deductible | $1,000 after deductible | 30% coinsurance after deductible |
Inpatient Maternity Care | $300 copay after deductible | $300 copay after deductible | 20% coinsurance after deductible |
Diagnostic Imaging (x-rays, ultrasounds) | Covered in full after deductible | $50 copay after deductible | 30% coinsurance after deductible |
Diagnostic Blood Work | Covered in full after deductible3 | $40 copay after deductible | 30% coinsurance after deductible |
Diagnostic Colonoscopies4 | $200 copay after deductible | $600 copay after deductible | 30% coinsurance after deductible |
Inpatient Rehabilitation (limit 100 days per year) | Covered in full after deductible | $400 copay after deductible | 30% coinsurance after deductible |
Inpatient Behavioral Health & Chemical Dependency | $300 copay after deductible | $300 copay after deductible | 30% coinsurance after deductible |
High-Tech Imaging (CAT scan, MRI/MRA, nuclear cardiology, PET scan) | Covered in full after deductible | $100 copay after deductible | 30% coinsurance after deductible |
Durable Medical Equipment | Covered in full after deductible | $40 copay after deductible | 30% coinsurance after deductible |
Outpatient Day Surgery | $200 copay after deductible | $600 copay after deductible | 30% coinsurance after deductible |
Urgent Care Center | $30 copay after deductible | $60 copay after deductible | 30% coinsurance after deductible |
Emergency Room | $200 copay after deductible | $200 copay after deductible | $200 copay per visit |
1The Preferred Network includes Rhode Island Hospital and its pediatric division, Hasbro Children’s; The Miriam Hospital; Newport Hospital; Bradley Hospital; Brown University Health Home Medical; Gateway Healthcare; Brown University Health Urgent Care Centers; Brown Health Medical Group; Brown Health Medical Group Primary Care; and related service locations. For a list of all providers in this network, use the Find a Doctor tool.
2The deductible and out-of- pocket limits are separate for the Preferred Network, National Blue Cross Network, and Out-of- Network services.
3A copay will apply if your lab specimen is sent out to any non-Preferred Network laboratory for processing.
4Preventive colonoscopies are covered once every 5 years starting at age 45.
This is a summary of benefits. It is not a contract. For details about coverage, including any limits and exclusions not noted here, please call (401) 429-2102 or 1-866-987-3706.
Looking for pharmacy & vision?
View pharmacy benefits on the ESI website
View vision benefits on the EyeMed website