Core Care Bronze 4

Plan Type: HMO
Plan Tier: Expanded Bronze
Individual Deductible $0.00
Family Deductible $0.00
Individual Out of Pocket Max $8,550.00
Family Out of Pocket Max $17,100.00
Primary Care Visit: $30.00
Specialist Visit: $90.00
Emergency Room: $1,600.00
Hospital - Physician: $90.00
Hospital - Facility: $1500 Copay per Day
Link to Full SBC: https://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/sbc-bronze4-2021.pdf
Plan Brochure: https://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2021.pdf

Other Coverage:

Child Dental: No
Adult Dental No

Prescription Drug Pricing:

Generic Drugs: $28.00
Non-Preferred Brand Drugs: 50% Coinsurance after deductible
Preferred Brand Drugs: $125.00
Specialty Drugs: 50% Coinsurance after deductible
Summary of Benefits https://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2021.pdf

This Carrier Offers:



About The Carrier

Molina Healthcare, a FORTUNE 500, multi-state health care organization, arranges for the delivery of health care services and offers health information management solutions to nearly five million individuals and families who receive their care through Medicaid, Medicare and other government-funded programs in fifteen states.

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