Gym Access IND Silver HMO BC 0941
| Plan Type: | HMO |
| Plan Tier: | Silver |
| Medical Deductible - Individual: | $5600 |
| Medical Deductible - Family: | $3000 |
| Drug Deductible - Individual: | $5600 |
| Drug Deductible - Family: | $3000 |
| Out of Pocket Max - Individual: | $7150 |
| Out of Pocket Max - Family: | $7150 |
| Primary Care Visit: | $50 |
| Specialist Visit: | $100 |
| Emergency Room: | $400 Copay after deductible |
| Hospital - Physician: | No Charge |
| Hospital - Facility: | $600 Copay per Stay after deductible |
| Link to Full SBC: | http://www.fhcp.com/documents/ISBC/2020/56503FL2550002-01.pdf |
| Plan Brochure: | http://www.fhcp.com/documents/ISOB/2020/56503FL2550002-01.pdf |
Other Coverage:
| Child Dental: | No |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $10 |
| 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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