Wellpoint

Wellpoint Essential Silver Value 4500 ($0 Virtual PCP + $0 Select Drugs + I

Plan Overview

Medical Deductible
  • Individual: $4,500
  • Family: $9,000
  • Per Person: $4,500
Prescription Drug Deductible
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical
Medical Out-of-Pocket Maximum
  • Individual: $7,600
  • Family: $15,200
  • Per Person: $7,600
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $35.00 Copay

Prescription Drug Information

Generic Drugs
  • Standard: $25.00 Copay

Inpatient Coverage

Hospital Services
  • Standard: $500.00 Copay after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: $75.00 Copay
Coverage provided by Wellpoint Maryland, Inc.