OMNIA Silver

Health Insurance Plan Details (2024 Plan)

by Horizon Blue Cross Blue Shield of New Jersey

Monthly Premium

EPO
$ubsidy
Silver
Deductible
$1,600 /yr
Max Out-of-Pocket
$9,450 /yr

Details

Deductible (per individual) $1,600 /yr
Deductible (per family) $3,200 /yr
Max Out-of-Pocket (per individual) $9,450 /yr
Max Out-of-Pocket (per family) $18,900 /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 EPO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $30 Copay
Specialist Visit $50 Copay
Emergency Room $100 Copay with deductible
Inpatient Facility $500 Copay per Day after deductible
Inpatient Physician No Charge after deductible
Drug Costs
Generic Drugs $20 Copay
Preferred Brand Drugs 50.00% Coinsurance after deductible
Non-preferred Brand Drugs 50.00% Coinsurance after deductible
Specialty Drugs 50.00% Coinsurance after deductible

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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