Individual and Family Plans

Our Plans

Looking for low-cost health coverage? Jefferson Health Plans offers a range of plans in three metal tiers: Bronze, Silver, and Gold. Choose the right option for you!

Choose from a range of Individual and Family Plans that offer quality coverage and big savings. Count on us for affordable plans, access to hundreds of trusted providers, no referrals, and more! Review the plan information below to learn more.

Ready to enroll?

Call 1-833-608-0366 (TTY 711)

Shop Plans

By clicking Shop Plans, you will be redirected to pennie.com.

BRONZE

Premium Costs: $

Out-of-Pocket: $$$

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You don't go to the doctor often and want lower premiums

SILVER

Premium Costs: $$

Out-of-Pocket: $$

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You want to pay a lower premium and keep out-of-pocket costs lower

GOLD

Premium Costs: $$$

Out-of-Pocket: $

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You go to the doctor often and want lower out-of-pocket costs

Find the HMO or PPO plan for you

$0 Deductible + Bronze + HMO

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
FREE first primary care provider (PCP) visit*
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Need help finding the right plan for you? Call 1-833-435-1990 (TTY 711) to speak with a licensed benefits advisor.

Call now

$0 Deductible + Bronze + PPO

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Need help finding the right plan for you? Call 1-833-973-6131 (TTY 711) to speak with a licensed benefits advisor.

Call now

Member Benefits

No matter which plan you choose, you can count on these benefits:

Learn More

No Referrals Needed

Direct access to specialists and more.

$0 Virtual Visits

24/7 virtual care from the comfort of home through JeffConnect

Low-Cost Prescription Drugs

Coverage for generic and brand-name prescriptions.

Comprehensive Coverage

Complete coverage for medical and hospital care.

Affordable Plans

Choose from some of the most affordable plans on the marketplace.

Broad Network

Access to doctors, hospitals, and specialists near you.

Commonly Asked Questions

Yes! Our plans offer comprehensive medical and hospital coverage, plus more. Plans include the 10 Essential Health Benefits (EHBs) listed below:

Hospitalization
Prescription drugs
Laboratory services
Pregnancy, maternity and newborn care
Ambulatory outpatient services
Emergency services
Mental health and substance use disorders
Rehabilitative care
Preventive and wellness services
Chronic disease management

During Open Enrollment, which runs from November 1, 2023 to January 19, 2024 this year, you can buy a new plan, renew your plan, or make changes to your plan.

During the Special Enrollment Period, after January 19, 2024, you may be able to shop for or make changes to your plan if you have had a qualifying life event, including loss of health coverage, changes to your household like getting married or having a baby, or a change in residence.

If you applied for coverage through Pennie®, Pennsylvania’s official health insurance marketplace, and want to make changes to your plan, you will need to contact Pennie®.

With the Affordable Care Act, the federal government created four categories of coverage to help people more easily compare plans from different health insurance companies: Bronze, Silver, Gold and Platinum. Plans are assigned to one of these levels based on what percentage of the cost of health care services is covered by the health insurance company.

All products cover the Essential Health Benefits (EHBs) set forth by the ACA, such as doctor visits, prescription drugs, X-rays and hospital stays. The major differences are in what you pay when you need these services and the monthly cost of the health plan.

A primary care provider (PCP) is the doctor you see for most of your health care needs. To find a primary care provider, use our online directory, or call us at 1-833-422-4690 (TTY 1-877-454-8477).

*Please note that the provider directory is branded with Health Partners Plans, our former company name. We will be updating the branding to Jefferson Health Plans in the near future.

HMO stands for Health Maintenance Organization. HMO health plans require you to select a primary care physician, or PCP who will be your main medical contact for routine care and to refer you to other in-network providers when needed for specialty care. Services are covered when you seek care from providers within the HMO network. If you go outside of the network for care, typically only emergency services are covered.

Jefferson Health Plans require you to choose doctors and hospitals within the HMO network. If you need assistance finding the right in-network provider, use our online directory.

*Please note that the provider directory is branded with Health Partners Plans, our former company name. We will be updating the branding to Jefferson Health Plans in the near future.

Yes. With JeffConnect, you can access a board-certified provider 24/7. JeffConnect is a convenient and affordable alternative to an office visit or urgent care when you have a medical concern that is not an emergency.

Yes. All plans from Jefferson Health Plans cover mental health and substance abuse services.

Your health care coverage is considered in-network when you use a provider, hospital, or facility that participates in our HMO network. To find out if a provider is in-network, use our online directory.

Yes. With Jefferson Health Plans, you are covered for medically necessary services for unexpected illnesses or emergency care no matter where you seek care.

Yes. All Jefferson Health Plans provide prescription drug coverage. Many plans offer low-cost Tier 1 and Tier 2 generic prescription drugs to help you save.

The drug formulary is a list of medications selected by Jefferson Health Plans for their medical effectiveness, positive results and value. It includes all generic medications plus a defined list of brand-name medications. You can save money by utilizing medications that are included on the formulary.

To locate a participating pharmacy, use our convenient search tool. You can also call us at 1-833-435-1990.

Yes. Our health plans actually offer low-cost generic Tier 1 and Tier 2 drugs with no deductibles. Generic drugs are as safe and effective as brand-name drugs and could cost less.

Tier 1 prescription drugs are commonly prescribed preferred generic drugs. Tier 2 prescription drugs are also generic drugs, but they cost a little more than those in Tier 1. In many cases, you can save money by choosing these types of drugs over more expensive brand-name ones.

A copay, copayment, is the fee you pay when you see a doctor or receive other services.

A deductible is the amount you pay each year before your health plan starts paying for covered services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for health services. Once you have paid this amount, your insurance will begin to pay a portion, or all, of your health care costs, depending on the health plan.

If you choose a health plan with a high deductible, you will have a lower monthly premium. If you choose a health plan with a low deductible, you will have a higher monthly premium.

This is the maximum amount you’ll pay for health care services in a plan year. Care for covered services you receive after you reach the out-of-pocket maximum will be fully covered by the health plan. Out-of-pocket maximums vary by plan and can be found in your benefits brochure. The out-of-pocket maximum does not include premiums or charges for covered services that are not Essential Health Benefits (EHBs).

Our Plans

Premium Costs: $

Out-of-Pocket: $$$

Premium Costs: $$

Out-of-Pocket: $$

Premium Costs: $$$

Out-of-Pocket: $

HMO Plans

$0 Deductible + Bronze + HMO

Need help finding the right plan for you? Call 1-833-435-1990 (TTY 711) to speak with a licensed benefits advisor.

PPO Plans

$0 Deductible + Bronze + PPO

Need help finding the right plan for you? Call 1-833-973-6131 (TTY 711) to speak with a licensed benefits advisor.

What are the 10 Essential Health Benefits covered by Jefferson Health Plans’ Individual and Family Plans?

When can I buy or make changes to my health plan?

What do the metal levels mean?

What is a primary care provider (PCP)

What is an HMO?

Can I choose any doctor?

Do your health plans include virtual visits?

Are mental health services covered?

What does in-network mean?

Are emergency services covered?

Are prescription drugs covered?

What is a drug formulary?

How do I find an in-network pharmacy?

Are low-cost generic prescription drugs available?

What are Tier 1 and Tier 2 prescription drugs?

What is a copay?

What is a deductible?

What does out-of-pocket maximum mean?