South Dade – Medical Plan Highlights
BENEFITS | | HMO OA 6071 | HMO OA 6333 |
Annual Deductible Individual Family | $5,000 | $5,000 | $3,500 $7,000 |
Annual Out-Of-Pocket Maximum Individual Family | $6,350 $12,700 | $6,350 $12,700 | $6,850 $13,700 |
Primary | $60 | $35 | $35 |
Specialist Office Visit | $70 | $50 | $70 |
Inpatient Facility Charges | 30% after | 30% after deductible | $1000 |
Outpatient | 30% | 30% after deductible | $1000 |
Physician Services at Hospital / ER | $30% after deductible | 30% after deductible | 100% |
MRI, | $30% after deductible | 30% after deductible | $50 |
Emergency Room Copay (waived if admitted) | 30% | 30% | $600 |
Urgent Care Copay | $120 | $100 | $100 |
Prescriptions: Tier 1 / Tier 2 / Tier | $25/$50/$75/35% after deductible | $20/$50/$70/50% | $25/$50/$75/20% |
Employee | $74.72 | $115.52 | $133.88 |
Employee + Spouse | | | $356.76 |
Employee + Child(ren) | $222.07 | | $334.48 |
Employee + Family | $434.90 | | $623.92 |