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Plan Details

CommunityCare PPO Gold B19 Standard

Plan Year:

Gold Metal plans cover an estimated 80% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses.

Individual Deductible:$2,500
Individual Out of Pocket Maximum:$3,000
Office Visit Copay:$30
Out of Network Coinsurance:50%*
Preferred Generics:$15*
Preferred Brand Name:$45*
Non-Preferred Brand Name:$95*
Individual Rx Deductible:250
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
*Subject to the deductible

Essential Benefits

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services
  • Substance use disorder services
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices
  • Preventative and wellness services
  • Pediatric Services
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