Tradition Gold 30-50 Low Rx by CareConnect
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Tradition Gold 30-50 Low Rx
- Insurance Company
- CareConnect
In Network Benefits
- Office Co-pay
- $30
- Specialist Co-pay
- $50
- Hospital Co-pay
- 10% after deductible
- Emergency Room
- $200
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$50/50%(max $250)
- In-Network Co-Insurance
- 10%
- Max Out of Pocket (single/family)
- $3,000/$6,000
Out Of Network Benefits
- Deductible (single/family)
- N/A
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental
- Renewal Date
- Annual
- HSA Eligible
- No
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