August 4, 2020
Premium$26MOOP $4,500PCP$0Specialist$25Referrals RequiredNoInpatient Hospital$200 (days 1-5)Ambulatory Surgery Center$0 or $200Outpatient Hospital$0 or $200Lab Copay$0Rx Deductible$​0Rx Copays$3/$12/$47/$100/33%Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, OTC Catalog, continue reading
August 4, 2020
Premium$0MOOP $4,900PCP$0Specialist$30Referrals RequiredNoInpatient Hospital$245 (days 1-6)Ambulatory Surgery Center$0 or $245Outpatient Hospital$0 or $245Lab Copay$0Rx Deductible$95 tiers 4-5Rx Copays$3/$12/$47/$100/31%Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, continue reading
August 4, 2020
Premium$0MOOP $6,700PCP$0Specialist$50Referrals RequiredNoInpatient Hospital$350 (days 1-6)Ambulatory Surgery Center$0 or $350Outpatient Hospital$0 or $350Lab Copay$0Rx Deductible$405 tiers 3-5Rx Copays$3/$12/$47/$100/25%Key Extra BenefitsRoutine Eye Exam, Routine Hearing Exam, Hearing Aids, continue reading
August 4, 2020
Premium$28MOOP $4,900PCP$0Specialist$35Referrals RequiredNoInpatient Hospital$250 (days 1-6)Ambulatory Surgery Center$0 or $250Outpatient Hospital$0 or $250Lab Copay$0Rx Deductible$150 tiers 4-5Rx Copays$3/$12/$47/$100/33%Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, continue reading
August 4, 2020
Premium$0MOOP $5,900PCP$0Specialist$40Referrals RequiredNoInpatient Hospital$295 (days 1-6)Ambulatory Surgery Center$0 or $295Outpatient Hospital$0 or $295Lab Copay$0Rx Deductible$150 tiers 4-5Rx Copays$3/$13/$47/$100/30%Key Extra BenefitsDental Level 2, Routine Eye Exam, Eyewear Credit, continue reading
August 4, 2020
Premium$23MOOP $3,900PCP$0Specialist$25Referrals RequiredNoInpatient Hospital$250 (days 1-6)Ambulatory Surgery Center$0 or $250Outpatient Hospital$0 or $250Lab Copay$0Rx Deductible$150 tiers 4-5Rx Copays$3/$13/$47/$100/30%Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, continue reading
August 3, 2020
Premium$0MOOP $4,900PCP$0Specialist$35Referrals RequiredNoInpatient Hospital$295 (days 1-6)Ambulatory Surgery Center$0 or $295Outpatient Hospital$0 or $295Lab Copay$0Rx Deductible$150 tiers 4-5Rx Copays$3/$13/$47/$100/30%Key Extra BenefitsDental Level 4, Routine Eye Exam, Eyewear Credit, continue reading
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