ConnectiCare Benefits

Choice Catastrophic POS with Dental

Prescription Drug Information

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $9,200 Family: $18,400 Per Person: $9,200
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: $30.00 Copay, deductible does not apply for first 3 visits per year, combined with mental health and substance use disorder visits; then 0.00% Coinsurance after deductible
Specialist	Standard: 0.00% Coinsurance after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: 0.00% Coinsurance after deductible
Generic Drugs	Standard: 0.00% Coinsurance after deductible
Specialty Drugs	Standard: 0.00% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 0.00% Coinsurance after deductible