Platinum 121 by CDPHP
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Platinum 121
- Insurance Company
- CDPHP
In Network Benefits
- Office Co-pay
- $20
- Specialist Co-pay
- $20
- Hospital Co-pay
- $750
- Emergency Room
- $100
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $4/$30/$60
- In-Network Deductible (single/family)
- $0
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $7,350/$14,700
Out Of Network Benefits
- Co-Insurance
- N/A
- Deductible
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Vision Only
- Renewal Date
- Annual
- HSA Eligible
- No
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