Apply Off Pennie
Apply On Pennie
Available in all 21 counties
Off Pennie
$8,000 / $16,000
$8,550 / $17,100
None
$50 copay
$85 copay
Paid in full after deductible
$25 copay (deductible waived) for independent clinical labs / Paid in full after deductible for facility owned labs
Cost Share amounts listed in the chart are for service performed at in-network providers.
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Plan details
Doctor visits
Emergencies
Tests and lab work
Hospital services
Prescriptions
Highlight sheet
Summary of benefits and coverage
Subscriber agreement
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