HDHP Preventive Silver 5500 $0 Select Drugs

Health Insurance Plan Details (2025 Plan)

Monthly Premium

HMO
$ubsidy
HSA
Silver
Deductible
$5,500 /yr
Max Out-of-Pocket
$5,500 /yr

Details

Deductible (per individual) $5,500 /yr
Deductible (per family) $11,000 /yr
Max Out-of-Pocket (per individual) $5,500 /yr
Max Out-of-Pocket (per family) $11,000 /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
Medical Services
Preventive Care No Charge
Primary Care Visit No Charge after deductible
Specialist Visit No Charge after deductible
Emergency Room No Charge after deductible
Inpatient Facility No Charge after deductible
Inpatient Physician Not Applicable
Drug Costs
Generic Drugs No Charge after deductible
Preferred Brand Drugs No Charge after deductible
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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