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 33–39 of 39 results
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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/DENTAL 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