Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

Plan Type: HMO
Plan Tier: Silver
Individual Deductible $5,450
Family Deductible $10,900
Individual Out of Pocket Max $8,100
Family Out of Pocket Max $16,200
Primary Care Visit: $25
Specialist Visit: $50
Emergency Room: 30% Coinsurance after deductible
Hospital - Physician: 30% Coinsurance after deductible
Hospital - Facility: 30% Coinsurance after deductible
Link to Full SBC: https://api.centene.com/SBC/2021/70893GA0030032-01.pdf
Plan Brochure: https://www.ambetterhealth.com/content/dam/centene/ambetter-brochures/GA-2021.pdf

Other Coverage:

Child Dental: No
Adult Dental Yes

Prescription Drug Pricing:

Generic Drugs: $25
Non-Preferred Brand Drugs: 50% Coinsurance after deductible
Preferred Brand Drugs: $50
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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