Gym Access IND Gold HMO H.S.A 9010
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Medical Deductible - Individual: | $1500 |
| Medical Deductible - Family: | Not Applicable |
| Drug Deductible - Individual: | Not Applicable |
| Drug Deductible - Family: | Included in Medical |
| Out of Pocket Max - Individual: | $4000 |
| Out of Pocket Max - Family: | $4000 |
| Primary Care Visit: | 10% Coinsurance after deductible |
| Specialist Visit: | 10% Coinsurance after deductible |
| Emergency Room: | 10% Coinsurance after deductible |
| Hospital - Physician: | 10% Coinsurance after deductible |
| Hospital - Facility: | 10% Coinsurance after deductible |
| Link to Full SBC: | http://www.fhcp.com/documents/ISBC/2020/56503FL2860001-01.pdf |
| Plan Brochure: | http://www.fhcp.com/documents/ISOB/2020/56503FL2860001-01.pdf |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $10 Copay after deductible |
| Non-Preferred Brand Drugs: | $55 Copay after deductible |
| Preferred Brand Drugs: | $30 Copay after deductible |
| Specialty Drugs: | 50% Coinsurance after deductible |
| 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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