SoloCare - 2016 Individual & Family Plan Brochure

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SoloCare
40010
Silver
SoloCare
40015
Silver
SoloCare
40017
Silver
SoloCare
40019
Bronze
SoloCare
40021
Bronze
$30 co-pay $25 co-pay $20 co-pay $85 co-pay
$50 co-pay $60 co-pay $50 co-pay $125 co-pay
$75 co-pay $75 co-pay $75 co-pay $75 co-pay $75 co-pay
$250 co-pay $250 co-pay $250 co-pay $500 co-pay $250 co-pay
80% 80% 100% 50% 100%
$2,500/ $5,000 $3,000/ $6,000 $4,500/ $9,000 $6,200/ $12,400 $6,850/ $13,700
$6,850/ $13,700 $6,850/ $13,700 $6,850/ $13,700 $6,850/ $13,700 $6,850/ $13,700
$15 $15 $15
50% co-insurance
after medical
deductible
$50 $50 $50
$150 $150 $150
50% co-insurance
after medical
deductible
50% co-insurance
after medical
deductible
50% co-insurance
after medical
deductible
60% 60% 60% 30% 60%
$6,000/ $12,000 $12,000/ $24,000 $15,000/ $30,000 $15,000/ $30,000 $18,000/ $36,000
$18,000/ $36,000 $18,000/ $36,000 $18,000/ $36,000 $18,000/ $36,000 $39,000/ $78,000