Maine Community Health Options

Health Options Bronze $8000 Healthy Maine HMO Tiered NE

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Medical Deductible	Individual: $8,000 Family: $16,000 Per Person: $8,000
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

Primary Doctor	Standard: $50 Copay
Specialist	Standard: $80 Copay after deductible

Preferred Brand Drugs	Standard: 30% Coinsurance after deductible
Generic Drugs	Standard: $30 Copay

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