Ambetter Secure Care 1 (2020) with 3 Free PCP Visits
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $1,000 |
| Medical Deductible - Family: | $2,000 |
| Drug Deductible - Individual: | $500 |
| Drug Deductible - Family: | $1,000 |
| Out of Pocket Max - Individual: | $6,350 |
| Out of Pocket Max - Family: | $12,700 |
| Primary Care Visit: | 20% Coinsurance after deductible |
| Specialist Visit: | 20% Coinsurance after deductible |
| Emergency Room: | $250 Copay after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | https://api.centene.com/SBC/2019/41047OH0010004-01.pdf |
| Plan Brochure: | https://api.centene.com/Brochures/2019/41047OH0010004-01.pdf |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $10 |
| Non-Preferred Brand Drugs: | $75 Copay after deductible |
| Preferred Brand Drugs: | $25 Copay after deductible |
| Specialty Drugs: | 30% Coinsurance after deductible |
| Link to Full Policy Formulary: | https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html |
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