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Health First Commercial Plans, Inc.

Health First Silver VALUE 80 1815

Plan Overview

Medical Deductable
  • Individual: $6,500.00
  • Family: $13,000
  • Per Person: $6,500
Prescription Drug Deductible
  • Individual: $200.00
  • Family: $400
  • Per Person: $200
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Virtual Health provided as a means to receive this benefit.
Specialist
  • CoPay: $100.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Virtual Health provided as a means to receive this benefit.

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: $30.00 Copay after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered
Non Preferred Brand Drugs
  • CoPay: $55.00 Copay after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered
Generic Drugs
  • CoPay: $15.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Preferred Generic Drugs: $15 copay for 30 days' supply.
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: 25.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Coverage is limited to 30-day supply from preferred specialty pharmacy.

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Coverage for inpatient rehabilitation services are limited to 21 days per calendar year.
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
Urgent Care Facility
  • CoPay: $80.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Virtual Health provided as a means to receive this benefit.

Maternity

Labor and Delivery Hospital Stay
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: $0.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Visits 16+ and visits with a perinatologist are subject to the Specialist Visit cost-share.

Vision

Routine Eye Exams For Children
  • CoPay: $0.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Exam(s) per Year
  • Benefit Explanation: Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Major Dental Care

Routine Dental Checkups for Children
  • CoPay: $0.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per 6 Months
  • Benefit Explanation: Covered up through the end of the birth month in which the covered person reaches age nineteen (19). Basic and major dental care and orthodontic services.
Routine Dental Checkups for Adults
  • Covered: Not Covered
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