Smiling Father and Daughter by Tree

Plan overview

Plan availability

County of residence

Available in Lancaster county

Exchange

On and off Pennie

Covered services


Plan details

You pay

Deductible (individual / family)

Choice 1: $7,100 / $14,200

Choice 2: $8,550 / $17,100

Out-of-pocket max (individual / family)

$8,550 / $17,100

Coinsurance

Choice 1: None

Choice 2: None


Doctor visits

You pay

Primary care office visit

Choice 1: $50 copay

Choice 2: Paid in full after deductible

Specialist office visit

Choice 1: $85 copay

Choice 2: Paid in full after deductible


Emergencies

You pay

Emergency room

Paid in full after Choice 1 deductible

Urgent care

Paid in full after Choice 1 deductible


Tests and lab work

You pay

Diagnostic lab services

Paid in full after deductible

Outpatient diagnostic test (X-ray)

Paid in full after deductible

Outpatient high tech imaging

Paid in full after deductible


Hospital services

You pay

Outpatient surgery service

Paid in full after deductible

Inpatient hospital admission

Paid in full after deductible


Prescriptions

You pay

Retail Rx

Paid in full after deductible

Home delivery Rx

Paid in full after deductible


Cost Share amounts listed in the chart are for service performed at in-network providers.