Maine Community Health Options

Health Options Clear Choice Bronze $6300 HSA PPO NE

Prescription Drug Information

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Plan Overview

Medical Deductible	Individual: $6,300 Family: $12,600 Per Person: $6,300
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $7,500 Family: $15,000 Per Person: $7,500
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: 50% Coinsurance after deductible
Specialist	Standard: 50% Coinsurance after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: 50% Coinsurance after deductible
Generic Drugs	Standard: 50% Coinsurance after deductible