July 22, 2020
Star RatingPremium$18Part B GivebackNoPCP in-network$0Specialist in-network$35Inpatient Hospital$300 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$35- $225: SURMedical Deductible$0MOOP in-network$6,900 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingNot AvailablePremium$0Part B GivebackNoPCP in-network$0Specialist in-network$25Inpatient Hospital$300 (days 1-4) ; $0 (days 5-90)Outpatient Hospital Services$25- $300: SURMedical Deductible$0MOOP in-network$5,500 Rx Deductible$0Prescription drug coverage (at preferred continue reading
July 22, 2020
Star RatingPremium$18Part B GivebackNoPCP in-network$0Specialist in-network$45Inpatient Hospital$350 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$45- $310: SURMedical Deductible$0MOOP in-network$4,950 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$25Inpatient Hospital$295 (days 1-6) ; $0 (days 7-90)Outpatient Hospital Services$25- $200: SURMedical Deductible$0MOOP in-network$5,000 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$35Inpatient Hospital$390 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$35- $295: SURMedical Deductible$0MOOP in-network$6,900 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$35Inpatient Hospital$375 (days 1-4) ; $0 (days 5-90)Outpatient Hospital Services$35- $375: SURMedical Deductible$0MOOP in-network$7,000 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingPremium$0Part B GivebackYesPCP in-network$5Specialist in-network$50Inpatient Hospital$390 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$50- $275: SURMedical Deductible$0MOOP in-network$7,500 Rx Deductible$150Prescription drug coverage (at preferred pharmacies)Tier continue reading
July 22, 2020
Star RatingNot AvailablePremium$0Part B GivebackNoPCP in-network$0Specialist in-network$20Inpatient Hospital$250 (days 1-4) ; $0 (days 5-90)Outpatient Hospital Services$20- $250: SURMedical Deductible$0MOOP in-network$4,500 Rx Deductible​$0Prescription drug coverage (at preferred continue reading
July 22, 2020
Star RatingNot AvailablePremium$0Part B GivebackNoPCP in-network$0Specialist in-network$25Inpatient Hospital$325 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$25- $325: SURMedical Deductible$0MOOP in-network$5,500 Rx Deductible​$0Prescription drug coverage (at preferred continue reading
July 22, 2020
Star RatingPremium$0Part B GivebackNoPCP in-network$0Specialist in-network$30Inpatient Hospital$300 (days 1-5) ; $0 (days 6-90)Outpatient Hospital Services$30- $245: SURMedical Deductible$0MOOP in-network$6,500 Rx DeductibleN/APrescription drug coverage (at preferred pharmacies)Tier continue reading
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