F Gold EPO 15 35 Non-Gated by Oxford
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Plan Information
- Plan Name
- F Gold EPO 15 35 Non-Gated
- Insurance Company
- Oxford
In Network Benefits
- Office Co-pay
- $15
- Specialist Co-pay
- $35
- Hospital Co-pay
- 10% after deductible
- Emergency Room
- $500
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $15 (deductible waived)/$35/$75 after deductible
- In-Network Deductible (single/family)
- $1,000/$2,000
- In-Network Co-Insurance
- 10%
- Max Out of Pocket (single/family)
- $5,250/$10,500
Out Of Network Benefits
- Co-Insurance
- N/A
- Deductible
- 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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