Standard HMOs
Depending on where you live or work, in many parts of the state, you
may also select a Standard HMO.
With a Standard HMO you must use network providers to receive benefits
- no benefits are paid when you use out-of-network providers, except in medical emergencies. In addition,
set dollar copays keep your costs more predictable.
View a list of the Standard HMOs that
will be offered and the areas where each is available. The
Benefit Statement you receive will show the specific HMO options available
to you. Use the Health Plan Cost Estimator
to compare your options.
Plan Highlights
| Covers care received in network only |
| No annual deductible |
|
|
|
$0 |
|
|
$0 |
|
What you pay for care received
|
|
|
|
$20/visit for PCP; $40/visit for specialists
|
|
|
$250
|
|
Prescription drugs
|
|
|
|
$7/retail; $14/mail order
|
|
|
$30/retail; $60/mail order
|
|
|
$50/retail; $100/mail order
|
|
Annual out-of-pocket maximum
|
|
|
|
$1,500
|
|
|
$3,000
|
|
Preventive care (coverage based on age and gender): Certain routine physical exams, health screenings, and immunizations.
|
See the HMO's Certificate of Coverage (COC) or Summary Plan Document (SPD).
|
|