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

Health Insurance Plan Details (2024 Plan)

Monthly Premium

PPO
$ubsidy
Platinum
Deductible
$750 /yr
Max Out-of-Pocket
$1,500 /yr

Details

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

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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