Imperial Insurance Companies, Inc. - Imperial Standard Bronze
Primary Care Visit
$50 Copay
100% Coinsurance
Specialist Visit
$100 Copay
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
50% Coinsurance after deductible
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
Laboratory Outpatient and Professional Services
50% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
50% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
50% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$25 Copay
100% Coinsurance
Preferred Brand Drugs
$50 Copay after deductible
100% Coinsurance
Non-Preferred Brand Drugs
$100 Copay after deductible
100% Coinsurance
Specialty drugs
$500 Copay after deductible
100% Coinsurance
Outpatient Facility Fee
50% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
50% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
50% Coinsurance after deductible
50% Coinsurance after deductible
Emergency Transportation/Ambulance
50% Coinsurance after deductible
50% Coinsurance after deductible
Urgent Care
$75 Copay
$75 Copay
Inpatient Hospital Services
50% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
50% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
$50 Copay
100% Coinsurance
Mental/Behavioral Health Inpatient Services
50% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
$50 Copay
100% Coinsurance
Substance Abuse Disorder Inpatient Services
50% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
$50 Copay
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
50% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
50% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
50% Coinsurance after deductible
100% Coinsurance
Habilitation Services
$50 Copay
100% Coinsurance
Skilled Nursing Facility
50% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
50% Coinsurance after deductible
100% Coinsurance
Hospice Services
50% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
$50 Copay
100% Coinsurance
Acupuncture
Not Covered
Not Covered
Rehabilitative Speech Therapy
$50 Copay
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
$50 Copay
100% Coinsurance
Well Baby Visits and Care
$0 Copay
100% Coinsurance
Allergy Testing
50% Coinsurance after deductible
100% Coinsurance
Diabetes Education
50% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
50% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
0% Coinsurance
100% Coinsurance
Eye Glasses for Children
0% Coinsurance
100% Coinsurance
Accidental Dental
50% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not Covered
Not Covered
Basic Dental Care (Child)
50% Coinsurance
100% Coinsurance
Dental Check Up (Child)
0% Coinsurance
100% Coinsurance
Major Dental Care (Adult)
Not Covered
Not Covered
Major Dental Care (Child)
50% Coinsurance after deductible
100% Coinsurance
Orthodontia (Adult)
Not Covered
Not Covered
Orthodontia (Child)
50% Coinsurance after deductible
100% Coinsurance
Routine Dental Services (Adult)
Not Covered
Not Covered