SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits
| Plan Type: | PPO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $750 |
| Medical Deductible - Family: | $1,500 |
| Drug Deductible - Individual: | Included in Medical |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $7,350 |
| Out of Pocket Max - Family: | $14,700 |
| Primary Care Visit: | $10 |
| Specialist Visit: | $50 |
| Emergency Room: | $300 Copay after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | http://www.summacare.com/Libraries/SBCs/2018SummaCareGold750SCConnectNetwork.sflb |
| Plan Brochure: | http://www.summacare.com/Libraries/SOBs/2018SummaCareGold750SCConnectNetwork.sflb |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $5 |
| Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Preferred Brand Drugs: | $50 |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb |
This Carrier Offers:
About The Carrier
SummaCare offers affordable medical insurance for employers, individuals, families and Medicare eligible individuals. It is our goal to consistently exceed our members’ expectations. That’s why you can expect the same great customer service with every interaction you have with SummaCare.
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