Empower MS500-IN24

Health Insurance Plan Details (2024 Plan)

by AvMed Health Plans

Monthly Premium

POS
$ubsidy
Silver
Deductible
$5,500 /yr
Max Out-of-Pocket
$8,000 /yr

Details

Deductible (per individual) $5,500 /yr
Deductible (per family) $11,000 /yr
Max Out-of-Pocket (per individual) $8,000 /yr
Max Out-of-Pocket (per family) $16,000 /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 POS
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $30 Copay
Specialist Visit $60 Copay
Emergency Room $550 Copay after deductible
Inpatient Facility $950 Copay per Stay after deductible
Inpatient Physician No Charge after deductible
Drug Costs
Generic Drugs $20 Copay
Preferred Brand Drugs $80 Copay
Non-preferred Brand Drugs $100 Copay
Specialty Drugs 50.00% 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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