CareSource Marketplace Gold Dental and Vision

Plan Type: HMO
Plan Tier: Gold
Medical Deductible - Individual: $2,000
Medical Deductible - Family: $4,000
Drug Deductible - Individual: Included in Medical
Drug Deductible - Family: Included in Medical
Out of Pocket Max - Individual: $6,500
Out of Pocket Max - Family: $13,000
Primary Care Visit: No Charge
Specialist Visit: $35
Emergency Room: 20% Coinsurance after deductible
Hospital - Physician: 20% Coinsurance after deductible
Hospital - Facility: 20% Coinsurance after deductible
Link to Full SBC: https://www.caresource.com/document/mp-2019-OH-std-goldbase-dv-sum
Plan Brochure: https://www.caresource.com/documents/mp-2019-OH-a-broch

Other Coverage:

Child Dental: Yes
Adult Dental Yes

Prescription Drug Pricing:

Generic Drugs: $10
Non-Preferred Brand Drugs: $200
Preferred Brand Drugs: $50
Specialty Drugs: 40% Coinsurance after deductible
Link to Full Policy Formulary: https://www.caresource.com/documents/2019-OH-marketplace-formulary/

About The Carrier

CareSource plans provide comprehensive, quality coverage that you can afford, understand and use. We offer individual and family plans with optional dental and vision coverage for adults. CareSource is a Qualified Health Plan offered through the Health Insurance Marketplace.

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