Gym Access IND Bronze HMO BC 3841
| Plan Type: | HMO |
| Plan Tier: | Expanded Bronze |
| Medical Deductible - Individual: | $6400 |
| Medical Deductible - Family: | Included in Medical |
| Drug Deductible - Individual: | $6400 |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $8000 |
| Out of Pocket Max - Family: | $8000 |
| Primary Care Visit: | $35 |
| Specialist Visit: | $65 |
| Emergency Room: | 50% Coinsurance after deductible |
| Hospital - Physician: | No Charge after Deductible |
| Hospital - Facility: | $100 Copay per Stay after deductible |
| Link to Full SBC: | http://www.fhcp.com/documents/ISBC/2020/56503FL2530002-01.pdf |
| Plan Brochure: | http://www.fhcp.com/documents/ISOB/2020/56503FL2530002-01.pdf |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $35 |
| Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Preferred Brand Drugs: | 35% Coinsurance after deductible |
| Specialty Drugs: | 45% Coinsurance after deductible |
| Link to Full Policy Formulary: | http://fm.formularynavigator.com/FBO/126/2020_QHP_Formulary_Member_Doc.pdf |
[et_pb_dp_dmb_module_3718 _builder_version="3.17.5" /][et_pb_dp_dmb_module_3741 _builder_version="3.17.5" /][et_pb_dp_dmb_module_3739 _builder_version="3.17.5" /]
Countdown to Start of Open Enrollment
Day(s)
:
Hour(s)
:
Minute(s)
:
Second(s)
[et_pb_dp_dmb_module_5544 _builder_version="3.19.18" /][et_pb_dp_dmb_module_3740 _builder_version="3.17.5" buttontext="Apply Today" appcalltoactiontext="Don't Delay the Start of Your New Coverage" /]