Illinois health plan · 2025

QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL · 85773IL0030071

Quartz Health Benefit Plans Corporation offers this marketplace health insurance plan (Plan ID 85773IL0030071) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Expanded Bronze Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Quartz Health Benefit Plans Corporation
Telehealth Data pending HSA eligible No Dental Not listed Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 63.53% (36.47% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$313 – $1226

Before subsidies

Estimate after subsidies

Deductible

$7,250

$14500 per group

See deductible details

Max out-of-pocket

$7,250

$14500 per group

Review MOOP rules

Office visits

Primary care No Charge after deductible
Specialist No Charge after deductible
HSA Not eligible

Drug tiers

Generic No Charge after deductible
Preferred brand No Charge after deductible

View formulary tiers

$428 / mo before subsidies

≈ $5140 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1357 / mo before subsidies

≈ $16288 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1644 / mo before subsidies

≈ $19726 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1045 / mo before subsidies

≈ $12536 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

No Charge after deductible

Durable Medical Equipment

0.00% Coinsurance after deductible

Advertisement

Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Illinois). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

No Charge after deductible

Durable Medical Equipment

0.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 85773IL0030071
Coverage year 2025
State Illinois
Issuer Quartz Health Benefit Plans Corporation
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 85773IL0030071-03
Available variants

Standard Off Exchange Plan · 85773IL0030071-00

Standard On Exchange Plan · 85773IL0030071-01

Open to Indians below 300% FPL · 85773IL0030071-02

Open to Indians above 300% FPL · 85773IL0030071-03
Last plan update Fri, 25 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Illinois N/A
PCPs in Illinois N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['ILN002']

Providers Illinois All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,920 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 1,565
NON-PREFERRED 1,339
SPECIALTY 625
PREFERRED-BRAND 391
Prior authorization Drugs
Required 773
Not Required 3,147
Step therapy Drugs
Required 58
Not Required 3,862
Quantity limits Drugs
Has Limit 875
No Limit 3,045

Customer highlights

What stands out for members

  • Issuer: Quartz Health Benefit Plans Corporation · Plan ID 85773IL0030071 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 85773IL0030071-03 (Open to Indians above 300% FPL) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Diabetes Education

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Services must be rendered by a physician, or duly certified, or licensed health care professional with expertise in diabetes management.

Exclusions: nan

Home Health Care Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Covered for duration of medically necessary care

Exclusions: nan

Laboratory Outpatient and Professional Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Benefit provided for outpatient services and when these services are related to surgery or medical care.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Benefit Period

Limited to 60 Visits for all therapy disciplines combined. Maintenance Therapy not covered.

Exclusions: nan

Rehabilitative Speech Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Benefit Period

Limited to 60 Visits for all therapy disciplines combined. Maintenance Therapy not covered.

Exclusions: nan

Specialist Visit

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network No Charge after deductible

nan

Exclusions: nan

X-rays and Diagnostic Imaging

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Benefit provided for outpatient services and when these services are related to surgery or medical care.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Copay per Day

Exclusions: nan

Dialysis

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network No Charge after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 0.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Benefit Period

Limited to 60 Visits for all therapy disciplines combined. Maintenance therapies not covered.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Transplant

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 2.0 Item(s) per 2 Years

Benefits are for bone anchored hearing aids. Quantity limit applies to hearing aids for children.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Benefits will be available for that care from the moment of birth up to the first 31 days, thereafter, you must add the newborn child to your Family Coverage.

Exclusions: nan

Routine Eye Exam for Children

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Benefit Period

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Brand Drugs

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Specialty Drugs

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Abortion services are covered at no greater cost-sharing than applicable to other pregnancy-related health services.

Exclusions: nan

Acupuncture

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 12.0 Visit(s) per Benefit Period

Acupuncture services are covered only when provided for the treatment of nausea or vomiting when associated with pregnancy, chemotherapy, or for the treatment of chronic pain, including migraine or tension headaches, fibromyalgia, chronic neck and back pain, knee pain due to arthritis, or myofascial pain. Acupuncture is not covered for the treatment of any other conditions. Services must be obtained from licensed acupuncture providers or licensed physicians.

Exclusions: nan

Allergy Testing

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Requires Prior Authorization and must be performed at an approved health center.

Exclusions: nan

Cosmetic Surgery

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered. Characterized in the certificates as "reconstructive surgery," as it is not considered truly cosmetic.

Exclusions: nan

Eye Glasses for Children

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per Benefit Period

nan

Exclusions: nan

Gender Affirming Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Habilitation Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Benefit Period

Limited to 60 Visits for all therapy disciplines combined. Treatment must be medically necessary and therapeutic and not investigational.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limitations vary based on procedures.

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Reconstructive Surgery

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Only includes benefits for mastectomy-related services.

Exclusions: nan

Routine Eye Exam (Adult)

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Benefit Period

1 preventive visit covered per benefit year covered without member cost sharing; subject to applicable cost sharing thereafter.

Exclusions: nan

Routine Foot Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Only covered for persons diagnosed with diabetes.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Virtual Visit

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Variant attributes

QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL · Variant 85773IL0030071-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

85773IL003

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

85773IL0030071-03

Plan Marketing Name

QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL

Plan Variant Marketing Name

QUARTZ PERFORMANCE BRONZE (VISION) $7250 DED LIMITED COST SHARE - IL

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

85773

Issuer Marketplace Marketing Name

Quartz

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ILN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Foreign claims for emergency care are subject to a maximum benefit of $20,000 per benefit year.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization

Service Area ID

ILS002

State Code

IL

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.635333560017943

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$7,250

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$5,400

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,800

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$14500 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7250 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,250

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ILF016

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

0.9966

First Tier Utilization

100%

Import Date

2024-10-25 20:01:38

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Specialist Requiring a Referral

Except for in-network care for behavioral health and substance use disorder services, you need to obtain a referral or standing referral from your Primary Care Provider before you obtain specialty care.

Plan ID

85773IL0030071

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$14500 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$7250 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$7,250

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Illinois?

QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL (85773IL0030071) is a Expanded Bronze HMO from Quartz Health Benefit Plans Corporation in Illinois for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Adult, Child.

Does QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Foreign claims for emergency care are subject to a maximum benefit of $20,000 per benefit year.

Does QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization

How do I enroll in or manage payments for QUARTZ PERFORMANCE BRONZE (VISION) $7250 HSA - IL?

Use the issuer portal https://hixenroll.quartzbenefits.com to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.