Gym Access IND Gold HMO 4500
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $2200 |
| Medical Deductible - Family: | Included in Medical |
| Drug Deductible - Individual: | $2200 |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $4500 |
| Out of Pocket Max - Family: | $4500 |
| Primary Care Visit: | $25 |
| Specialist Visit: | $35 |
| Emergency Room: | 10% Coinsurance after deductible |
| Hospital - Physician: | No Charge |
| Hospital - Facility: | $250 Copay per Day |
| Link to Full SBC: | http://www.fhcp.com/documents/ISBC/2020/56503FL2090002-01.pdf |
| Plan Brochure: | http://www.fhcp.com/documents/ISOB/2020/56503FL2090002-01.pdf |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $10 |
| Non-Preferred Brand Drugs: | $55 |
| Preferred Brand Drugs: | $30 |
| Specialty Drugs: | $0.50 |
| Link to Full Policy Formulary: | http://fm.formularynavigator.com/FBO/126/2020_QHP_Formulary_Member_Doc.pdf |
This Carrier Offers:
About The Carrier
Florida Health Care Plan, Inc. (FHCP) provides health care services. The Company offers health insurance, medicare plans, and other related services. FHCP serves members in the State of Florida.
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