Med Benchmark Platinum

Health Insurance Plan Details (2024 Plan)

Monthly Premium

HMO
$ubsidy
Platinum
Deductible
$0 /yr
Max Out-of-Pocket
$8,950 /yr

Details

Deductible (per individual) $0 /yr
Deductible (per family) $0 /yr
Max Out-of-Pocket (per individual) $8,950 /yr
Max Out-of-Pocket (per family) $17,900 /yr
Drug Deductible (per individual) $0
Drug Deductible (per family) $0
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type HMO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit No Charge
Specialist Visit No Charge
Emergency Room $250 Copay
Inpatient Facility 10% Coinsurance
Inpatient Physician 10% Coinsurance
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $45 Copay
Non-preferred Brand Drugs 50% Coinsurance
Specialty Drugs 50% Coinsurance

Plan Documents

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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