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Silver 40 75 4700 Pro EPO by Healthfirst New York

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Plan Information

Plan Name
Silver 40 75 4700 Pro EPO
Insurance Company
Healthfirst New York

In Network Benefits

Office Co-pay
$40
Specialist Co-pay
$75
Hospital Co-pay
45% after deductible
Emergency Room
$600 after deductible
Referrals Needed
No
Rx: Generic/Brand/High Brand
$20/$60/$110
In-Network Deductible (single/family)
$4,700/$9,400
In-Network Co-Insurance
45%
Max Out of Pocket (single/family)
$7,900/$15,800

Out Of Network Benefits

Deductible (single/family)
N/A
Co-Insurance
N/A
Out of Pocket Max (single/family)
N/A

Other Benefits

Vision/Dental
Pediatric Vision and Dental
HSA Eligible
No

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