SoloCare Platinum PPO Chiro - $0 PCP, $0 Generic Rx

Health Insurance Plan Details (2024 Plan)

SBC doc

doctor lookup

drug list

PPO

Platinum

Deductible (per individual)	$750 /yr
Deductible (per family)	$1,500 /yr
Max Out-of-Pocket (per individual)	$1,500 /yr
Max Out-of-Pocket (per family)	$3,000 /yr
Drug Deductible (per individual)	Included in Medical
Drug Deductible (per family)	Included in Medical
Drug Max Out-of-Pocket (per individual)	Included in Medical
Drug Max Out-of-Pocket (per family)	Included in Medical
Plan Type	PPO
Includes Child Dental?	No
Includes Adult Dental?	No

Medical Services
Preventive Care	No Charge
Primary Care Visit	No Charge
Specialist Visit	20% Coinsurance after deductible
Emergency Room	20% Coinsurance after deductible
Inpatient Facility	20% Coinsurance after deductible
Inpatient Physician	20% Coinsurance after deductible

Drug Costs
Generic Drugs	No Charge
Preferred Brand Drugs	20% Coinsurance after deductible
Non-preferred Brand Drugs	20% Coinsurance after deductible
Specialty Drugs	20% Coinsurance after deductible

Summary of Benefits and Coverage	SBC doc
Provider Directory	Doctor lookup
Drug Formulary List	drug list

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible

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