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Silver 70 Off Exchange Ambetter PPO + Adult Dental & Vision
Health Insurance Plan Details (2025 Plan)
by Health Net of California, Inc
Monthly Premium
PPO
$ubsidy
Silver
- Deductible
- $5,400 /yr
- Max Out-of-Pocket
- $8,700 /yr
Details
Deductible (per individual) | $5,400 /yr |
Deductible (per family) | $10,800 /yr |
Max Out-of-Pocket (per individual) | $8,700 /yr |
Max Out-of-Pocket (per family) | $17,400 /yr |
Drug Deductible (per individual) | |
Drug Deductible (per family) | |
Drug Max Out-of-Pocket (per individual) | |
Drug Max Out-of-Pocket (per family) | |
Plan Type | PPO |
Includes Child Dental? | Yes |
Includes Adult Dental? | Yes |
Out-of-Pocket Costs
Preventive Care | No Charge |
Primary Care Visit | $50 Copay |
Specialist Visit | $90 Copay |
Emergency Room | $400 Copay |
Inpatient Facility | 30.00% Coinsurance after deductible |
Inpatient Physician | 30.00% Coinsurance |
Generic Drugs | $18 Copay |
Preferred Brand Drugs | $60 Copay after deductible |
Non-preferred Brand Drugs | $90 Copay after deductible |
Specialty Drugs | 20.00% Coinsurance after deductible |
Plan Documents
Summary of Benefits and Coverage | SBC doc |
Provider Directory | Doctor lookup |
Drug Formulary List | n/a |
* 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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