Benefits Essential Plan 3 Costs & Co-pays
Individual Deductible $0
Individual Maximum Out-of-Pocket $0
Inpatient Hospital Care $0
Emergency Care $0
Urgent Care $0
Outpatient Hospital Services $0
X-rays and Labs $0
Advanced Imaging $0
PCP Office Visits $0
Specialist Office Visits $0
Adult Dental NC/Covered Covered at No Cost
Adult Vision NC/Covered Covered at No Cost
Non-Prescription Drugs Covered at No Cost
Non-Emergency Transportation Covered at No Cost
Generic drugs $1
Preferred Brand Drugs $3
Non-Preferred Brand and Specialty $3
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