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Individuals (one-person plans) and families (two or more people) may qualify for Smart Select; however, all people covered by Smart Select must be under 65 years old. (Please see Medicare plans if you’re over 65 or are eligible for Medicare.) Smart Select is medically underwritten.
| Plan type | HMO |
|---|---|
| Eligibility | Individuals and families under 65 years old* |
| Coinsurance | You pay 20% in network |
| Flat copayments | $30 office visits, $35 urgent care visits, $200 ER visits |
| Included coverage |
|
| Unique benefits | Unlimited primary care physician visits covered before deductible |
There are three options for families or individuals to choose from, and when you're looking at pricing, it's good to keep this in mind: your deductible affects how high your premium will be and what kind of benefits you'll receive.
| Deductible | Out-of-pocket maximum | Monthly rate |
| For individuals: | Starts at $79.17 |
||
|---|---|---|---|
| Plan 1500 | $1,500 | $6,500 | |
| Plan 2500 | $2,500 | $7,500 | |
| Plan 5000 | $5,000 | $10,000 | |
| For families: | |||
| Plan 3000 | $3,000 | $13,000 | |
| Plan 5000 | $5,000 | $15,000 | |
| Plan 10000 | $10,000 | $20,000 |
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| Options |
| Plan Structure: | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Network | PPO | PPO | HMO | HMO | |||||||
| Prescription Coverage | Yes $10 copay for generic 50% for brand name or specialty drugs |
Yes 50% after deductible |
Yes $4 copay for generic $60 copay for brand name |
Yes $5 copay for generic $50 copay for brand name |
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| Maternity Coverage | No | Yes, optional rider available | Yes, includes pre and post natal visits and delivery and newborn care after separate $3,000 deductible | Yes, includes pre and post natal visits and delivery and newborn care | |||||||
| Dental Coverage | Optional (Personal Blue Dental or Personal Blue Dental Plus) | Optional (Flexible Blue Dental Plus) | Optional (Personal Blue Dental or Personal Blue Dental Plus) | Optional (Personal Blue Dental or Personal Blue Dental Plus) | |||||||
| Included Services | Preventive medical | Preventive medical | Preventive medical | Preventive medical | |||||||
| Unique Benefits | Accidental Injury Deductible Waiver and wellness incentives including diminishing deductible and fitness rewards | HSA-compatible | Unlimited primary care physician office visits | Unlimited primary care physician office visits | |||||||
| Possible Costs: | |||||||||||
| Deductible |
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|
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$500 ind. $1,000 fam. |
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| Out-of-pocket maximum |
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|
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$5,500 ind. $11,000 fam. |
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| Fixed copays include | $40 office visits $75 urgent care $250 ER visits (waived if admitted) |
$50 urgent care $150 ER visits (waived if admitted) |
$30 office visits $35 urgent care $200 ER visits (waived if admitted) |
$30 office visits $35 urgent care $100 ER visits (waived if admitted) |
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| Coinsurance | You pay 30% in-network You pay 50% out-of-network |
You pay 20% in-network You pay 40% out-of-network |
You pay 20% in-network | You pay 20% in-network | |||||||
| Other Highlights | |||||||||||
| Waiting period for preexisting conditions | 180 days | 180 days | 180 days | 180 days |
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