AdventHealth GYM ACCESS Silver HMO 100 1676
| Plan Type: | HMO |
| Plan Tier: | Silver |
| Medical Deductible - Individual: | $4650 |
| Medical Deductible - Family: | $200 |
| Drug Deductible - Individual: | $4650 |
| Drug Deductible - Family: | $400 |
| Out of Pocket Max - Individual: | $8150 |
| Out of Pocket Max - Family: | $8150 |
| Primary Care Visit: | $25 Copay after deductible |
| Specialist Visit: | $50 Copay after deductible |
| Emergency Room: | No Charge after Deductible |
| Hospital - Physician: | No Charge after Deductible |
| Hospital - Facility: | No Charge after Deductible |
| Link to Full SBC: | http://myAHplan.com/2020_sbc_1676 |
| 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: | 20% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://myAHplan.com/MP_formulary_2020 |
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