2024 POS 4200 Silver Select

Health Insurance Plan Details (2024 Plan)

by Health Alliance Medical Plans, Inc.

Monthly Premium

POS
$ubsidy
Silver
Deductible
$4,200 /yr
Max Out-of-Pocket
$8,750 /yr

Details

Deductible (per individual) $4,200 /yr
Deductible (per family) $8,400 /yr
Max Out-of-Pocket (per individual) $8,750 /yr
Max Out-of-Pocket (per family) $17,500 /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? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $35 Copay
Specialist Visit $55 Copay
Emergency Room 40.00% Coinsurance after deductible
Inpatient Facility 40.00% Coinsurance after deductible
Inpatient Physician 40.00% Coinsurance after deductible
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $40 Copay
Non-preferred Brand Drugs $80 Copay
Specialty Drugs $250 Copay

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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