Silver Cost-Sharing 73 Connected Care

The cost-sharing versions of our Connected Care and Access plans are only available to individuals with certain income levels. Check your eligibility for (or purchase) these plans here. Have questions? Just call us at 855-447-2900.

Silver 73 Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $3,300
Family: $6,600
Individual: $9,900
Family: $19,800
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $6,000
Family: $12,000
Individual: $18,000
Family: $36,000
Co-insurance
(What’s this?)
You pay 40% You pay 60%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
1st 3 visits $40 copay then $40 copay per visit after deductible You pay 60% after deductible
Specialist Office Visits You pay $65 copay per visit after deductible You pay 60% after deductible
Emergency Room Visits You pay 40% after deductible You pay 40% after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 30% per drug
Tier 3 Non-Preferred: You pay 40% per drug
Tier 4 Specialty: You pay 50% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 50% after deductible
Tier 2 Preferred Brand: You pay 50% after deductible
Tier 3 Non-Preferred: You pay 50% after deductible
Tier 4 Specialty: You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 60% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $65 copay per visit after deductible You pay 60% after deductible
Diagnostic X-Ray & Lab Services You pay 40% after deductible You pay 60% after deductible
Inpatient Hospital Services You pay 40% after deductible You pay 60% after deductible
Maternity You pay 40% after deductible You pay 60% after deductible
Physician, Surgical & Medical Services You pay 40% after deductible You pay 60% after deductible
Physical, Occupational & Speech Therapy You pay 40% after deductible You pay 60% after deductible

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Silver 73 Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $2,150
Family: $4,300
Individual: $6,450
Family: $12,900
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $5,200
Family: $10,400
Individual: $15,600
Family: $31,200
Co-insurance
(What’s this?)
You pay 40% You pay 60%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $35 copay per visit after deductible You pay 60% after deductible
Specialist Office Visits You pay $65 copay per visit after deductible You pay 60% after deductible
Emergency Room Visits You pay $200 copay per visit after deductible You pay $200 copay per visit after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 30% per drug
Tier 3 Non-Preferred: You pay 40% per drug
Tier 4 Specialty: You pay 50% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 50% after deductible
Tier 2 Preferred Brand: You pay 50% after deductible
Tier 3 Non-Preferred: You pay 50% after deductible
Tier 4 Specialty: You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 60% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $65 copay per visit after deductible You pay 60% after deductible
Diagnostic X-Ray & Lab Services You pay 40% after deductible You pay 60% after deductible
Inpatient Hospital Services You pay 40% after deductible You pay 60% after deductible
Maternity You pay 40% after deductible You pay 60% after deductible
Physician, Surgical & Medical Services You pay 40% after deductible You pay 60% after deductible
Physical, Occupational & Speech Therapy You pay 40% after deductible You pay 60% after deductible

Get PricingDownload a comparison chart

Silver Cost-Sharing 73 Connected Care

In Network Out of Network
Deductible
(What’s This?)
$2,150 individual
$4,300 family
$6,450 individual
$12,900 family
Annual Out-of-Pocket Maximum
(What’s this?)
$5,500 individual
$11,000 family
$16,500 individual
$33,000 family
Co-insurance
(What’s this?)
You pay 40% You pay 60%
Primary Care Provider and Non-Specialist Office Visits
(Find a Provider)
First 3 visits before deductible: $35 copay per visit; after deductible: $35 copay per visit You pay 60% after deductible
Specialist Office Visits $65 copay after deductible You pay 60% after deductible
Emergency Room Visits $200 copay after deductible $200 copay after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 25% per drug
Tier 2 Preferred Brand: You pay 30% per drug
Tier 3 Non-preferred: You pay 50% per drug
Tier 4 Specialty: You pay 50% per drug
Tier 5 Non-preferred Specialty: You pay 50% per drug
You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network – deductible does not apply You pay 60% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
$65 copay per visit after deductible You pay 60% after deductible
Diagnostic X-Ray & Lab Services You pay 40% after deductible You pay 60% after deductible
Inpatient Hospital Services You pay 40% after deductible You pay 60% after deductible
Maternity You pay 40% after deductible You pay 60% after deductible
Physician, Surgical & Medical Services You pay 40% after deductible You pay 60% after deductible
Physical, Occupational & Speech Therapy
$65 copay per visit after deductible You pay 60% after deductible

Get Pricing