Gold Embrace EPO 221 by CDPHP
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Plan Information
- Plan Name
- Gold Embrace EPO 221
- Insurance Company
- CDPHP
In Network Benefits
- Office Co-pay
- $30 after deductible
- Specialist Co-pay
- $50 after deductible
- Hospital Co-pay
- $1,000 after deductible
- Emergency Room
- $100 after deductible
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $10/$50/$80
- In-Network Deductible (single/family)
- $250/$500
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $7,150/$14,300
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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