ConnectiCare Benefits

Choice Bronze Alternative POS with Dental

Prescription Drug Information

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $7,000 Family: $14,000 Per Person: $7,000
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $9,200 Family: $18,400 Per Person: $9,200
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $50.00 Copay, deductible does not apply
Specialist	Standard: $70.00 Copay after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: $100.00 Copay after deductible
Generic Drugs	Standard: $30.00 Copay, deductible does not apply
Specialty Drugs	Standard: 50.00% Coinsurance after deductible to a maximum of $500 per prescription

Emergency and Urgent Care

Emergency Room

Standard: 45.00% Coinsurance after deductible