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
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