HMO Copayment 10 Platinum ST by CDPHP
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Plan Information
- Plan Name
- HMO Copayment 10 Platinum ST
- Insurance Company
- CDPHP
In Network Benefits
- Office Co-pay
- $15 after deductible
- Specialist Co-pay
- $35 after deductible
- Hospital Co-pay
- $500
- Emergency Room
- $100
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $10/$30/$60
- In-Network Deductible (single/family)
- $0
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $2,000/$4,000
Out Of Network Benefits
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision
- Renewal Date
- 01/01/2018
- HSA Eligible
- No
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