Metal Plan Details Minimum Coverage
Benefits in blue: Subject to a deductible
Benefits in black: Not subject to a deductible
The following benefits are for in-network services only. Before selecting a plan we recommend reviewing the plan’s Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) documents for specific costs and out-of-network benefits for PPO plans. There may be variations between plans that are not reflected here.
Standard Benefits for Individuals
Key benefits
Minimum Coverage
Individual Deductible
None
Preventative Care Copay
No cost
Primary Care Visit Copay
You pay $0 for first 3 visits*
Specialty Care Visit Copay
You pay $0 after OOP max
Urgent Care Visit Copay
You pay $0 for first 3 visits*
Lab Testing Copay
You pay $0 after OOP max
X-Ray Copay
You pay $0 after OOP max
Emergency Room Copay
You pay $0 after OOP max
High cost and infrequent services (e.g. Hospital Stay)
You pay $0 after OOP max
Tier 1 (most generics) Drug Copay
You pay $0 after OOP max
Tier 2 (preferred brand) Drug Copay
You pay $0 after OOP max
Tier 3 (non-preferred brand) Drug Copay
You pay $0 after OOP max
Tier 4 (specialty drugs)
You pay $0 after OOP max
Maximum Out-of-Pocket For One
$9,450
1 You receive 3 FREE office visits each year that are not subject to the deductible. Be aware that you do NOT get 3 of each type. You get 3 visits total, which may be used for primary care, urgent care, mental health, and substance use disorder treatment office visits.