SummaCare Silver 5000 40 with SCConnect Network
| Plan Type: | PPO |
| Plan Tier: | Silver |
| Medical Deductible - Individual: | $5,000 |
| Medical Deductible - Family: | $10,000 |
| Drug Deductible - Individual: | $2,000 |
| Drug Deductible - Family: | See Plan Brochure |
| Out of Pocket Max - Individual: | $7,350 |
| Out of Pocket Max - Family: | $14,700 |
| Primary Care Visit: | $25 |
| Specialist Visit: | 40% Coinsurance after deductible |
| Emergency Room: | 40% Coinsurance after deductible |
| Hospital - Physician: | 40% Coinsurance after deductible |
| Hospital - Facility: | 40% Coinsurance after deductible |
| Link to Full SBC: | http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver500040SCConnectNetwork.sflb |
| Plan Brochure: | http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver500040SCConnectNetwork.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: | 40% Coinsurance after deductible |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb |
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