Plan Name
(Click on link to view full benefit summary)
|
Deductible |
Description |
Summary of Benefit Design |
|
HM-OA-4078 |
500 |
First dollar coverage for office visits, Co-pay only plan after
meeting the Deductible |
HM-OA-4078 - Open Access HMO $25/$500; RX$20/$40/$60/$75 w/ OC |
|
HM-OA-3278 |
250 |
Deductible, Co-pay and Coinsurance |
Open Access HMO $20 / $250 / 10%; Rx $10/25/40/75 OC |
|
HM-OA-5064 |
2500 |
First dollar coverage for office visits, Co-pay only plan after meeting the
Deductible |
HM-OA-5064 - Open Access HMO 25/2500/1500;
RX$20/$40/$60/$75 w/ OC |
|
CH-CH-3705 |
750 |
Deductible, Co-pay and Coinsurance with added out of network benefit |
Choice 3BB; Rx $15/30/50/75 OC |
