CareSource Marketplace Gold Dental and Vision
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $2,000 |
| Medical Deductible - Family: | $4,000 |
| Drug Deductible - Individual: | Included in Medical |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $6,500 |
| Out of Pocket Max - Family: | $13,000 |
| Primary Care Visit: | No Charge |
| Specialist Visit: | $35 |
| Emergency Room: | 20% Coinsurance after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | https://www.caresource.com/document/mp-2019-OH-std-goldbase-dv-sum |
| Plan Brochure: | https://www.caresource.com/documents/mp-2019-OH-a-broch |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | Yes |
Prescription Drug Pricing:
| Generic Drugs: | $10 |
| Non-Preferred Brand Drugs: | $200 |
| Preferred Brand Drugs: | $50 |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Link to Full Policy Formulary: | https://www.caresource.com/documents/2019-OH-marketplace-formulary/ |
This Carrier Offers:
About The Carrier
CareSource plans provide comprehensive, quality coverage that you can afford, understand and use. We offer individual and family plans with optional dental and vision coverage for adults. CareSource is a Qualified Health Plan offered through the Health Insurance Marketplace.
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