Gold 202 – EPO
Network type: EPO
Coverage tier: Gold
SKU: 17575IN0700045
Categories: Advance, Akron, Alamo, Albany, Albion, Alexandria, Ambia, Amboy, Amo, Anderson, Andrews, Angola, Arcadia, Arcola, Argos, Arlington, Ashley, Atlanta, Attica, Atwood, Auburn, Austin, Avilla, Avoca, Avon, Bainbridge, Bargersville, Batesville, Bath, Battle Ground, Bedford, Beech Grove, Berne, Bethlehem, Beverly Shores, Bicknell, Birdseye, Blanford, Bloomfield, Bloomingdale, Bloomington, Bluffton, Boggstown, Boone Grove, Boonville, Borden, Boston, Boswell, Bourbon, Bowling Green, Branchville, Brazil, Bremen, Bridgeton, Bringhurst, Bristol, Bristow, Brook, Brooklyn, Brookston, Brownsburg, Brownstown, Brownsville, Bruceville, Bryant, Buck Creek, Buffalo, Bunker Hill, Burket, Burlington, Burnettsville, Butler, Butlerville, Cambridge City, Camby, Camden, Campbellsburg, Cannelburg, Cannelton, Carbon, Carlisle, Carmel, Carthage, Cayuga, Cedar Lake, Celestine, Centerpoint, Centerville, Central, Chalmers, Chandler, Charlestown, Charlottesville, Chesterton, Chrisney, Churubusco, Cicero, Clarks Hill, Clarksburg, Clarksville, Clay City, Claypool, Clayton, Clifford, Clinton, Cloverdale, Coal City, Coalmont, Coatesville, Colfax, Columbia City, Columbus, Commiskey, Connersville, Converse, Corunna, Cory, Corydon, Covington, Craigville, Crandall, Crane, Crawfordsville, Cromwell, Crothersville, Crown Point, Culver, Cutler, Cynthiana, Dale, Daleville, Dana, Danville, Darlington, Dayton, Decatur, Decker, Delong, Delphi, Demotte, Denver, Depauw, Deputy, Derby, Donaldson, Dublin, Dubois, Dugger, Dunkirk, Dunreith, Dupont, Dyer, Earl Park, East Chicago, Eaton, Eckerty, Economy, Edinburgh, Edwardsport, Elberfeld, Elizabeth, Elizabethtown, Elkhart, Ellettsville, Elnora, Elwood, Eminence, English, Etna Green, Evanston, Evansville, Fair Oaks, Fairbanks, Fairland, Fairmount, Falmouth, Farmersburg, Farmland, Ferdinand, Fillmore, Fishers, Flat Rock, Flora, Floyds Knobs, Fontanet, Forest, Fort Branch, Fort Wayne, Fortville, Fountain City, Fountaintown, Fowler, Fowlerton, Francesville, Francisco, Frankfort, Franklin, Frankton, Fredericksburg, Freedom, Freelandville, Freetown, Fremont, French Lick, Fulton, Galveston, Garrett, Gary, Gas City, Gaston, Geneva, Gentryville, Georgetown, Glenwood, Goldsmith, Goodland, Goshen, Gosport, Grabill, Grammer, Grandview, Granger, Grantsburg, Greencastle, Greenfield, Greens Fork, Greensboro, Greensburg, Greentown, Greenville, Greenwood, Griffin, Griffith, Grissom Arb, Grovertown, Gwynneville, Hagerstown, Hamilton, Hamlet, Hammond, Hanna, Hanover, Hardinsburg, Harlan, Harmony, Harrodsburg, Hartford City, Hartsville, Haubstadt, Hazleton, Hebron, Helmsburg, Heltonville, Hemlock, Henryville, Highland, Hillsboro, Hillsdale, Hoagland, Hobart, Hobbs, Holland, Homer, Hope, Howe, Hudson, Huntertown, Huntingburg, Huntington, Huron, Hymera, Idaville, Indiana, Indianapolis, Ingalls, Jamestown, Jasonville, Jasper, Jeffersonville, Jonesboro, Jonesville, Kempton, Kendallville, Kennard, Kentland, Kewanna, Keystone, Kimmell, Kingman, Kingsbury, Kingsford Heights, Kirklin, Knightstown, Knightsville, Knox, Kokomo, Kouts, La Crosse, La Fontaine, La Porte, Laconia, Ladoga, Lafayette, Lagrange, Lagro, Lake Station, Lake Village, Laketon, Lakeville, Lamar, Lanesville, Laotto, Lapaz, Lapel, Larwill, Leavenworth, Lebanon, Leesburg, Leiters Ford, Leo, Leopold, Lewis, Lewisville, Lexington, Liberty, Liberty Center, Liberty Mills, Ligonier, Lincoln City, Linden, Linton, Lizton, Logansport, Loogootee, Losantville, Lowell, Lucerne, Lynn, Lynnville, Lyons, Mackey, Macy, Manilla, Marengo, Marion, Markle, Markleville, Marshall, Martinsville, Marysville, Matthews, Mauckport, Maxwell, Mays, Mccordsville, Mecca, Medaryville, Medora, Mellott, Memphis, Mentone, Merom, Merrillville, Mexico, Miami, Michigan City, Michigantown, Middlebury, Middletown, Midland, Milford, Mill Creek, Millersburg, Milltown, Milroy, Milton, Mishawaka, Mitchell, Modoc, Mongo, Monon, Monroe, Monroe City, Monroeville, Monrovia, Monterey, Montezuma, Montgomery, Monticello, Montpelier, Mooreland, Mooresville, Morgantown, Morocco, Morristown, Mount Ayr, Mount Summit, Mount Vernon, Mulberry, Muncie, Munster, Nabb, Nappanee, Nashville, Needham, New Albany, New Carlisle, New Castle, New Goshen, New Harmony, New Haven, New Lisbon, New Market, New Middletown, New Palestine, New Paris, New Point, New Richmond, New Ross, New Salisbury, New Washington, New Waverly, Newberry, Newburgh, Newport, Newtown, Nineveh, Noblesville, Norman, North Judson, North Liberty, North Manchester, North Salem, North Vernon, North Webster, Notre Dame, Oakford, Oakland City, Oaktown, Oakville, Odon, Onward, Oolitic, Ora, Orestes, Orland, Orleans, Osceola, Ossian, Otisco, Otterbein, Otwell, Owensburg, Owensville, Oxford, Palmyra, Paoli, Paragon, Paris Crossing, Parker City, Patoka, Patricksburg, Paxton, Pekin, Pendleton, Pennville, Perrysville, Pershing, Peru, Petersburg, Petroleum, Pierceton, Pimento, Pine Village, Pittsboro, Plainfield, Plainville, Pleasant Lake, Plymouth, Poland, Poneto, Portage, Portland, Poseyville, Prairie Creek, Prairieton, Princeton, Putnamville, Quincy, Ragsdale, Ramsey, Redkey, Reelsville, Remington, Rensselaer, Reynolds, Richland, Richmond, Ridgeville, Riley, Roachdale, Roann, Roanoke, Rochester, Rockport, Rockville, Rolling Prairie, Rome, Rome City, Romney, Rosedale, Rossville, Royal Center, Rushville, Russellville, Russiaville, Saint Anthony, Saint Bernice, Saint Croix, Saint Joe, Saint John, Saint Mary Of The Woods, Saint Meinrad, Saint Paul, Salamonia, Salem, San Pierre, Sandborn, Santa Claus, Saratoga, Schererville, Schneider, Schnellville, Scipio, Scotland, Scottsburg, Sellersburg, Selma, Servia, Seymour, Sharpsville, Shelburn, Shelby, Shelbyville, Shepardsville, Sheridan, Shipshewana, Shirley, Shoals, Silver Lake, Smithville, Solsberry, Somerset, Somerville, South Bend, South Milford, South Whitley, Spencer, Spencerville, Spiceland, Springport, Springville, Spurgeon, Star City, State Line, Staunton, Stendal, Stilesville, Stinesville, Stockwell, Straughn, Stroh, Sullivan, Sulphur, Sulphur Springs, Sumava Resorts, Summitville, Swayzee, Sweetser, Switz City, Syracuse, Taswell, Taylorsville, Tell City, Templeton, Tennyson, Terre Haute, Thayer, Thorntown, Tippecanoe, Tipton, Topeka, Trafalgar, Troy, Tunnelton, Twelve Mile, Tyner, Underwood, Union City, Union Mills, Uniondale, Unionville, Universal, Upland, Urbana, Vallonia, Valparaiso, Van Buren, Veedersburg, Velpen, Vernon, Vincennes, Wabash, Wadesville, Wakarusa, Waldron, Walkerton, Walton, Wanatah, Warren, Warsaw, Washington, Waterloo, Waveland, Wawaka, Waynetown, Webster, West Baden Springs, West College Corner, West Lafayette, West Lebanon, West Newton, West Terre Haute, Westfield, Westphalia, Westpoint, Westport, Westville, Wheatfield, Wheatland, Wheeler, Whiteland, Whitestown, Whiting, Wilkinson, Williams, Williamsburg, Williamsport, Winamac, Winchester, Windfall, Wingate, Winona Lake, Winslow, Wolcott, Wolcottville, Wolflake, Woodburn, Worthington, Wyatt, Yeoman, Yoder, Yorktown, Young America, Zanesville, Zionsville
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | See brochure See brochure |
| Out-of-pocket max | N/A per person N/A per family |
| Metal tier | Gold |
Visit Copay
Urgent, Emergency Care, and Hospital Care
Maternitowny and Pregnancy
Pharmacy, Drugs, and Medication
Lab Tests and Diagnostic Procedures
Mental and Psychiatric Health Care
Health Plan Provider Information
| Health Plan Benefits | https://api.centene.com/SBC/2024/76179IN0140008-00.pdf |
| Drug and medication plan formulary | https://ambetter.mhsindiana.com/resources/pharmacy-resources.html |
| Search doctor list | https://ambetter.mhsindiana.com/findadoc |
