Ambetter Balanced Care 11 (2021)

Plan Type: HMO
Plan Tier: Silver
Individual Deductible $6,000
Family Deductible $12,000
Individual Out of Pocket Max $8,500
Family Out of Pocket Max $17,000
Primary Care Visit: $30
Specialist Visit: $60
Emergency Room: 40% Coinsurance after deductible
Hospital - Physician: 40% Coinsurance after deductible
Hospital - Facility: 40% Coinsurance after deductible
Link to Full SBC: https://api.centene.com/SBC/2021/70893GA0010018-01.pdf
Plan Brochure: https://www.ambetterhealth.com/content/dam/centene/ambetter-brochures/GA-2021.pdf

Other Coverage:

Child Dental: No
Adult Dental No

Prescription Drug Pricing:

Generic Drugs: $20
Non-Preferred Brand Drugs: 50% Coinsurance after deductible
Preferred Brand Drugs: $55
Specialty Drugs: 50% Coinsurance after deductible
Summary of Benefits https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html

About The Carrier

AmBetter from Buckeye Community Health Plan provides quality healthcare solutions that help residents of Georgia live better. With a variety of affordable coverage options, they make it easier to stay healthy.

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