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
Showing 33–46 of 46 results

Network type: HMO
Coverage tier: Gold
Primary care visit: $15 copay
Specialist visit: $90 copay
Urgent care visit: $90 copay

Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay

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

Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay

Network type: HMO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $80 copay
Urgent care visit: $60 copay

Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay

Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: first 3 visit(s) $60 then 35% after deductible copay, first 3 visit(s) $60 then 35% after deductible
Specialist visit: first 3 visit(s) $60 then 35% after deductible copay, first 3 visit(s) $60 then 35% after deductible
Urgent care visit: first 3 visit(s) $60 then 35% after deductible copay, first 3 visit(s) $60 then 35% after deductible

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: first 3 visit(s) $60 then 45% after deductible copay, first 3 visit(s) $60 then 45% after deductible
Specialist visit: first 3 visit(s) $60 then 45% after deductible copay, first 3 visit(s) $60 then 45% after deductible
Urgent care visit: first 3 visit(s) $60 then 45% after deductible copay, first 3 visit(s) $60 then 45% after deductible

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible

Network type: HMO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $35 copay
Urgent care visit: 20% after deductible

Network type: HMO
Coverage tier: Gold
Primary care visit: $20 copay
Specialist visit: $35 copay
Urgent care visit: $35 copay

Network type: HMO
Coverage tier: Silver
Primary care visit: 25% after deductible
Specialist visit: 25% after deductible
Urgent care visit: 25% after deductible

Network type: HMO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $95 copay
Urgent care visit: $95 copay