Neighborhood ESSENTIAL – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: $30 copay
Specialist visit: $65 copay
Urgent care visit: $65 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $2,650 per person $2,650 per person |
| Out-of-pocket max | $5,650 per person $11,300 per family |
| Metal tier | Gold |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | $65 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $65 copay |
| Emergency room | $350 copay |
| Hospital stay (facility) | No charge after deductible |
Maternitowny and Pregnancy
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $35 copay |
| Non-preferred Brand | $50 copay |
| Specialty | 30% after deductible |
