CareSource Marketplace Low Deductible Silver
| Plan Type: | HMO |
| Plan Tier: | Silver |
| Individual Deductible | $5,100 |
| Family Deductible | $10,200 |
| Individual Out of Pocket Max | $7,500 |
| Family Out of Pocket Max | $15,000 |
| Primary Care Visit: | $25 |
| Specialist Visit: | $60 |
| Emergency Room: | 20% Coinsurance after deductible |
| Hospital - Physician: | $500 Copay after deductible |
| Hospital - Facility: | $500 Copay per Stay after deductible |
| Link to Full SBC: | https://www.caresource.com/documents/Marketplace-2021-GA-LowDed-SilverBase-Basic-sum |
| Plan Brochure: | https://www.caresource.com/documents/Marketplace-2021-GA-brochure |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $20 |
| Non-Preferred Brand Drugs: | 20% Coinsurance after deductible |
| Preferred Brand Drugs: | $50 |
| Specialty Drugs: | 45% Coinsurance after deductible |
| Summary of Benefits | https://www.caresource.com/documents/Marketplace-2021-GA-formulary |
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