Silver Cost-Sharing 94 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 94 Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $0
Family: $0
Individual: $0
Family: $0
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $800
Family: $1,600
Individual: $2,400
Family: $4,800
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $10 per visit after deductible You pay 40%
Specialist Office Visits You pay $35 copay per visit after deductible You pay 40%
Emergency Room Visits You pay 20% after deductible You pay 20% 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 20% per drug
Tier 3 Non-Preferred: You pay 25% per drug
Tier 4 Specialty: You pay 30% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 40%
Tier 2 Preferred Brand: You pay 40%
Tier 3 Non-Preferred: You pay 40%
Tier 4 Specialty: You pay 40%
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $35 copay per visit You pay 40% after deductible
Diagnostic X-Ray & Lab Services You pay 20% after deductible You pay 40% after deductible
Inpatient Hospital Services You pay 20% after deductible You pay 40% after deductible
Maternity You pay 20% after deductible You pay 40% after deductible
Physician, Surgical & Medical Services You pay 20% after deductible You pay 40% after deductible
Physical, Occupational & Speech Therapy You pay 20% after deductible You pay 40% after deductible

Get PricingDownload a comparison chart

Silver 94 Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $0
Family: $0
Individual: $0
Family: $0
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $800
Family: $1,600
Individual: $2,400
Family: $4,800
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $10 per visit You pay 40%
Specialist Office Visits You pay $35 per visit You pay 40%
Emergency Room Visits You pay $100 copay per visit You pay $100 copay per visit
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 20% per drug
Tier 3 Non-Preferred: You pay 25% per drug
Tier 4 Specialty: You pay 30% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 40%
Tier 2 Preferred Brand: You pay 40%
Tier 3 Non-Preferred: You pay 40%
Tier 4 Specialty: You pay 40%
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $35 copay per visit You pay 40% after deductible
Diagnostic X-Ray & Lab Services You pay 20% after deductible You pay 40% after deductible
Inpatient Hospital Services You pay 20% after deductible You pay 40% after deductible
Maternity You pay 20% after deductible You pay 40% after deductible
Physician, Surgical & Medical Services You pay 20% after deductible You pay 40% after deductible
Physical, Occupational & Speech Therapy You pay 20% after deductible You pay 40% after deductible

Get PricingDownload a comparison chart

Silver Cost-Sharing 94 Connected Care

In Network Out of Network
Deductible
(What’s This?)
$0 individual
$0 family
$0 individual
$0 family
Annual Out-of-Pocket Maximum
(What’s this?)
$800 individual
$1,600 family
$2,400 individual
$4,800 family
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider and Non-specialist Office Visits
(Find a Provider)
$10 copay per visit You pay 40% after deductible
Specialist Office Visits $35 copay per visit You pay 40%
Emergency Room Visits $100 copay per visit $100 copay per visit
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 15% per drug
Tier 3 Non-Preferred: You pay 35% per drug
Tier 4 Specialty: You pay 35% per drug
Tier 5 Non-preferred Specialty: You pay 35% per drug
You pay 40% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network – deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
$35 copay per visit You pay 40% after deductible
Diagnostic X-Ray & Lab Services $35 copay per visit You pay 40% after deductible
Inpatient Hospital Services $35 copay per visit You pay 40% after deductible
Maternity $35 copay per visit You pay 40% after deductible
Physician, Surgical & Medical Services $35 copay per visit You pay 40% after deductible
Physical, Occupational & Speech Therapy
$35 copay per visit You pay 40% after deductible

Get Pricing