SELECT GOLD I403-01 HSA – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible
Showing 209–224 of 291 results
-
-
SELECT GOLD I410-01 STANDARD W/DENTAL W/FIXED COPAY – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $45 copay -
SELECT GOLD I410-01 STANDARD W/FIXED COPAY – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $45 copay -
SELECT GOLD I420-01 VALUE TIER RX – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: $15 copay
Specialist visit: $90 copay
Urgent care visit: $90 copay -
Select Plan Basic – HMO
Network type: HMO
Coverage tier: Low
Basic Dental: 30%
Major dental care: 43%
Orthodontics: 54%
Exams: $10 -
Select Plan Premium – HMO
Network type: HMO
Coverage tier: High
Basic Dental: 27%
Major dental care: 41%
Orthodontics: 54%
Exams: $10 -
SELECT SILVER I303-01 VALUE TIER RX – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay -
SELECT SILVER I304-01 HSA – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible -
SELECT SILVER I308-01 VALUE TIER RX W/FIXED COPAY – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay -
SELECT SILVER I309-01 STANDARD – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $80 copay
Urgent care visit: $60 copay -
SELECT SILVER I320-01 VALUE TIER RX – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay -
SELECT SILVER I320-01 VALUE TIER RX W/DENTAL – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay -
Silver 1 250 – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $45 copay -
Silver 1 250 with Adult Vision Services – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $45 copay -
Silver 1003 – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $50 copay after deductible
Specialist visit: 40% after deductible
Urgent care visit: 40% after deductible -
Silver 1007 – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $75 copay
Urgent care visit: $55 copay