Individual Health Plans

HDHMO Qualified 33

In-Network Deductible
Individual: $2,500 | Family: $5,000

Preventive Care
$0

Office Visit
15%

Specialist Visit
15%

Prescription Drugs
Tier 1: $4 Tier 2: 50% Tier 3: 50%

Urgent Care
15%

Emergency Room
15%

Inpatient Hospital
15%

Outpatient Surgery
15%

Plan Documents
Summary of Benefits & Coverage
Health Plan Contract

In-Network Deductible
Individual: $2,000 | Family: $4,000

Preventive Care
$0

Office Visit
$30

Specialist Visit
$540

Prescription Drugs
Tier 1: $10 Tier 2: $35 Tier 3: $70

Urgent Care
$70

Emergency Room
$250

Inpatient Hospital
$1,500

Outpatient Surgery
$100

Plan Documents
Summary of Benefits & Coverage
Health Plan Contract

In-Network Deductible
Individual: $3,000 | Family: $6,000

Preventive Care
$0

Office Visit
10%

Specialist Visit
10%

Prescription Drugs
Tier 1: $4 Tier 2: 30% Tier 3: 50%

Urgent Care
10%

Emergency Room
10%

Inpatient Hospital
10%

Outpatient Surgery
10%

Plan Documents
Summary of Benefits & Coverage
Health Plan Contract