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 |
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