Market HMO 5250 HSA – Mercy
Plan Type: | HMO |
Plan Tier: | Bronze |
Medical Deductible - Individual: | $5,250 |
Medical Deductible - Family: | $10,500 |
Drug Deductible - Individual: | Included in Medical |
Drug Deductible - Family: | Included in Medical |
Out of Pocket Max - Individual: | $6,650 |
Out of Pocket Max - Family: | $13,300 |
Primary Care Visit: | No Charge after Deductible |
Specialist Visit: | No Charge after Deductible |
Emergency Room: | No Charge after Deductible |
Hospital - Physician: | No Charge after Deductible |
Hospital - Facility: | No Charge after Deductible |
Link to Full SBC: | https://mybrokerlink.com/GetSbc?mmi=005006016000000000 |
Plan Brochure: |
Other Coverage:
Child Dental: | No |
Adult Dental | No |
Prescription Drug Pricing:
Generic Drugs: | $40 Copay after deductible |
Non-Preferred Brand Drugs: | 50% Coinsurance after deductible |
Preferred Brand Drugs: | $80 Copay after deductible |
Specialty Drugs: | 50% Coinsurance after deductible |
Link to Full Policy Formulary: | https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx |
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