Ambetter Balanced Care 25 HSA (2021)

Plan Type: HMO
Plan Tier: Silver
Individual Deductible $4,800
Family Deductible $9,600
Individual Out of Pocket Max $4,800
Family Out of Pocket Max $9,600
Primary Care Visit: No Charge after Deductible
Specialist Visit: No Charge after Deductible
Emergency Room: No Charge after Deductible
Hospital - Physician: No Charge after Deductible
Hospital - Facility: No Charge after Deductible
Link to Full SBC: https://api.centene.com/SBC/2021/70893GA0010031-01.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: No Charge after Deductible
Non-Preferred Brand Drugs: No Charge after Deductible
Preferred Brand Drugs: No Charge after Deductible
Specialty Drugs: No Charge 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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