Headquarter
217-04 Northern Blvd
Bayside, NY 11361
Get in touch
718-461-8300
info@solomonus.com
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| Benefits | Essential Plan 1 Costs & Co-pays |
|---|---|
| Individual Deductible | $0 (Med/Rx combined) |
| Individual Maximum Out-of-Pocket | $2,000 (Med/Rx combined) |
| Inpatient Hospital Care | $150 |
| Emergency Care | $75 |
| Urgent Care | $25 |
| Outpatient Hospital Services | $50 |
| X-rays and Labs | PCP: $15 SPC: $25 OP Facility: $50 |
| Advanced Imaging | $25 |
| PCP Office Visits | $15 |
| Specialist Office Visits | $25 |
| Adult Dental NC/Covered | Not Covered/$15 if covered |
| Adult Vision NC/Covered | Not Covered/$15 if covered |
| Non-Prescription Drugs | Not Covered |
| Non-Emergency Transportation | Not Covered |
| Generic drugs | $6 |
| Preferred Brand Drugs | $15 |
| Non-Preferred Brand and Specialty | $30 |