iDirect Gold Copay Gold NS OON IHC Network Marketplace Dep29

Health Insurance Plan Details (2024 Plan)

by Independent Health Benefits Corporation

Monthly Premium

POS
$ubsidy
Gold
Deductible
$1,250 /yr
Max Out-of-Pocket
$6,750 /yr

Details

Deductible (per individual) $1,250 /yr
Deductible (per family) $2,500 /yr
Max Out-of-Pocket (per individual) $6,750 /yr
Max Out-of-Pocket (per family) $13,500 /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 POS
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $20 Copay
Specialist Visit $50 Copay after deductible
Emergency Room $150 Copay after deductible
Inpatient Facility $1000 Copay per Stay after deductible
Inpatient Physician No Charge after deductible
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $40 Copay
Non-preferred Brand Drugs 50.00% Coinsurance
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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