Begin Primary Care Cost-Sharing After Number Of Visits
3
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Drug EHB Deductible, Combined In/Out of Network, Family Per Group
per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person
per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual
Not Applicable
Drug EHB Deductible, In Network (Tier 1), Family Per Group
$0 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person
$0 per person
Drug EHB Deductible, In Network (Tier 1), Individual
$0
Drug EHB Deductible, Out of Network, Family Per Group
per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person
per person not applicable
Drug EHB Deductible, Out of Network, Individual
Not Applicable
Disease Management Programs Offered
Heart Disease, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium
0.998
First Tier Utilization
100%
Limited Cost Sharing Plan Variation - Estimated Advanced Payment
$0.00
New/Existing Plan
Existing
Notice Required for Pregnancy
No
Is a Referral Required for Specialist?
No
Medical EHB Deductible, Combined In/Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person
per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual
Not Applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Group
$3600 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person
$1800 per person
Medical EHB Deductible, In Network (Tier 1), Individual
$1,800
Medical EHB Deductible, Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person
per person not applicable
Medical EHB Deductible, Out of Network, Individual
Not Applicable
Plan Effective Date
1/1/2026
Plan Expiration Date
12/31/2026
Wellness Program Offered
No