Benefits | Essential Plan 2 Costs & Co-pays |
---|---|
Individual Deductible | $0 (Med/Rx combined) |
Individual Maximum Out-of-Pocket | $200 (Med/Rx combined) |
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 | Not Covered/$0 if covered |
Adult Vision NC/Covered | Not Covered/$0 if covered |
Non-Prescription Drugs | Not Covered |
Non-Emergency Transportation | Not Covered |
Generic drugs | $1 |
Preferred Brand Drugs | $3 |
Non-Preferred Brand and Specialty | $3 |
Solomon Agency Corp.