2024 POS 0 Elite Platinum

Health Insurance Plan Details (2024 Plan)

by Health Alliance Medical Plans, Inc.

Monthly Premium

POS
$ubsidy
Platinum
Deductible
$0 /yr
Max Out-of-Pocket
$3,200 /yr

Details

Deductible (per individual) $0 /yr
Deductible (per family) $0 /yr
Max Out-of-Pocket (per individual) $3,200 /yr
Max Out-of-Pocket (per family) $6,400 /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 POS
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $10 Copay
Specialist Visit $20 Copay
Emergency Room $100 Copay
Inpatient Facility $350 Copay per Stay
Inpatient Physician No Charge
Drug Costs
Generic Drugs $5 Copay
Preferred Brand Drugs $10 Copay
Non-preferred Brand Drugs $50 Copay
Specialty Drugs $150 Copay

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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