SoloCare Gold PPO 40002 Area 9
| Plan Type: | PPO |
| Plan Tier: | Gold |
| Individual Deductible | $2,300 |
| Family Deductible | $4,600 |
| Individual Out of Pocket Max | $8,550 |
| Family Out of Pocket Max | $17,100 |
| Primary Care Visit: | $20 |
| Specialist Visit: | $40 |
| Emergency Room: | 20% Coinsurance after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | https://alliantplans.com/2021/solocare/40002_01.pdf |
| Plan Brochure: | https://alliantplans.com/2021/solocare-2021-brochure.pdf |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | No |
Prescription Drug Pricing:
| Generic Drugs: | $15 |
| Non-Preferred Brand Drugs: | $150 |
| Preferred Brand Drugs: | $50 |
| Specialty Drugs: | 50% Coinsurance after deductible |
| Summary of Benefits | https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtNTk5 |
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