Connect Silver 3000 Indiv Med Deductible

Health Insurance Plan Details (2025 Plan)

Monthly Premium

EPO
$ubsidy
Silver
Deductible
$3,000 /yr
Max Out-of-Pocket
$8,500 /yr

Details

Deductible (per individual) $3,000 /yr
Deductible (per family) $6,000 /yr
Max Out-of-Pocket (per individual) $8,500 /yr
Max Out-of-Pocket (per family) $17,000 /yr
Drug Deductible (per individual) $2,000
Drug Deductible (per family) $4,000
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type EPO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $20 Copay
Specialist Visit $45 Copay
Emergency Room $750 and 40% Coinsurance after deductible
Inpatient Facility $950 Copay per Day
Inpatient Physician 40% Coinsurance after deductible
Drug Costs
Generic Drugs $3 Copay
Preferred Brand Drugs $50 Copay after deductible
Non-preferred Brand Drugs 49% Coinsurance after deductible
Specialty Drugs 50% 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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