Wellpoint

Wellpoint Essential Gold 1500 ($0 Virtual PCP + $0 Select Drugs + Incentive

Plan Overview

Medical Deductible
  • Individual: $1,500
  • Family: $3,000
  • Per Person: $1,500
Prescription Drug Deductible
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical
Medical Out-of-Pocket Maximum
  • Individual: $6,500
  • Family: $13,000
  • Per Person: $6,500
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $25.00 Copay

Prescription Drug Information

Generic Drugs
  • Standard: $5.00 Copay

Inpatient Coverage

Hospital Services
  • Standard: 35.00% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: $50.00 Copay
Coverage provided by Wellpoint Maryland, Inc.