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Individual Health Plans

HDHMO Qualified 33

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In-Network Deductible
Individual: $2,500  |  Family: $5,000
Preventive Care
$0
Office Visit
15%
Video Doctor Visits
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
2018 Summary of Benefits & Coverage
 2018 Health Plan Contract

Standard HMO Copayment 30

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In-Network Deductible
Individual: $2,000  |  Family: $4,000
Preventive Care
$0
Office Visit
$30
Video Doctor Visits
$30
Specialist Visit 
$50
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
2018 Summary of Benefits & Coverage
 2018 Health Plan Contract

HMO Smart Deductible 34

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In-Network Deductible
Individual: $4,300  |  Family: $8,600
Preventive Care
$0
Office Visit
10%
Video Doctor 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
2018 Summary of Benefits & Coverage
 2018 Health Plan Contract

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