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Clear Silver
Health Insurance Plan Details (2025 Plan)
by Ambetter from WellCare of Kentucky
Monthly Premium
HMO
$ubsidy
Silver
- Deductible
- $6,500 /yr
- Max Out-of-Pocket
- $6,500 /yr
Details
Deductible (per individual) | $6,500 /yr |
Deductible (per family) | $13,000 /yr |
Max Out-of-Pocket (per individual) | $6,500 /yr |
Max Out-of-Pocket (per family) | $13,000 /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 | HMO |
Includes Child Dental? | No |
Includes Adult Dental? | No |
Out-of-Pocket Costs
Preventive Care | No Charge |
Primary Care Visit | $50 Copay |
Specialist Visit | $100 Copay |
Emergency Room | Not Applicable |
Inpatient Facility | Not Applicable |
Inpatient Physician | Not Applicable |
Generic Drugs | Not Applicable |
Preferred Brand Drugs | Not Applicable |
Non-preferred Brand Drugs | Not Applicable |
Specialty Drugs | Not Applicable |
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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