AdventHealth GYM ACCESS Gold HMO 70 1743
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $1500 |
| Medical Deductible - Family: | $200 |
| Drug Deductible - Individual: | $1500 |
| Drug Deductible - Family: | $400 |
| Out of Pocket Max - Individual: | $4100 |
| Out of Pocket Max - Family: | $4100 |
| Primary Care Visit: | $40 |
| Specialist Visit: | $80 |
| Emergency Room: | $250 |
| Hospital - Physician: | No Charge |
| Hospital - Facility: | $700 Copay per Stay |
| Link to Full SBC: | http://myAHplan.com/2020_sbc_1743 |
| Plan Brochure: |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $15 |
| Non-Preferred Brand Drugs: | $50 Copay after deductible |
| Preferred Brand Drugs: | $30 Copay after deductible |
| Specialty Drugs: | 30% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://myAHplan.com/MP_formulary_2020 |
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