CareSource Kentucky Co.

Silver 5000 $20 Generic Drugs

Prescription Drug Information

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $5,000 Family: $10,000 Per Person: $5,000
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,000 Family: $16,000 Per Person: $8,000
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $40.00
Specialist	Standard: $80.00

Prescription Drug Information

Preferred Brand Drugs	Standard: $40.00
Non Preferred Brand Drugs	Standard: $80.00 Copay after deductible
Generic Drugs	Standard: $20.00
Specialty Drugs	Standard: $350.00 Copay after deductible

Emergency and Urgent Care

Emergency Room

Standard: Not Applicable