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PPO Access 3000 - Flex
Health Insurance Plan Details (2025 Plan)
by Harvard Pilgrim Health Care Inc.
Monthly Premium
PPO
$ubsidy
Silver
- Deductible
- $3,000 /yr
- Max Out-of-Pocket
- $9,200 /yr
Details
Deductible (per individual) | $3,000 /yr |
Deductible (per family) | $6,000 /yr |
Max Out-of-Pocket (per individual) | $9,200 /yr |
Max Out-of-Pocket (per family) | $18,400 /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 | PPO |
Includes Child Dental? | Yes |
Includes Adult Dental? | No |
Out-of-Pocket Costs
Preventive Care | No Charge |
Primary Care Visit | $50 Copay |
Specialist Visit | $75 Copay |
Emergency Room | $1000 Copay after deductible |
Inpatient Facility | $1000 Copay per Stay after deductible |
Inpatient Physician | No Charge after deductible |
Generic Drugs | $5 Copay |
Preferred Brand Drugs | $80 Copay |
Non-preferred Brand Drugs | $120 Copay |
Specialty Drugs | 20.00% Coinsurance |
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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