M Silver EPO 30-60 Non-Gated by Oxford
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Plan Information
- Plan Name
- M Silver EPO 30-60 Non-Gated
- Insurance Company
- Oxford
In Network Benefits
- Office Co-pay
- $30
- Specialist Co-pay
- $60
- Hospital Co-pay
- 30% after deductible
- Emergency Room
- 30% after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10(deductible waived)/$65/$90 after $100 deductible
- In-Network Deductible (single/family)
- $2,500/$5,000
- In-Network Co-Insurance
- 30%
- 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
- Pediatric Vision and Dental
- Renewal Date
- Annual
- HSA Eligible
- No
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