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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