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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
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