SoloCare - 2016 Individual & Family Plan Brochure

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SoloCare
60031
Silver
SoloCare
60036
Silver
SoloCare
60038
Silver
SoloCare
60039
Bronze
SoloCare
60041
Bronze
$30 co-pay $25 co-pay $20 co-pay $100 co-pay
$75 co-pay $60 co-pay $50 co-pay $150 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 $250 co-pay $250 co-pay
80% 80% 100% 50% 100%
$3,425/ $6,850 $4,800/ $9,600 $5,850/ $11,700 $6,000/ $12,000 $6,850/ $13,700
$6,850/ $13,700 $6,000/ $12,000 $6,850/ $13,700 $6,850/ $13,700 $6,850/ $13,700
$10 $10 $10
Subject to deductible except preventive,
which remains 0% cost-share
$35 $35 $35
$60 $60 $60
60% 60% 60% 30% 60%
$13,425/ $26,850 $10,000/ $20,000 $10,000/ $20,000 $15,000/ $30,000 $15,000/ $30,000
$15,000/ $30,000 $15,000/ $30,000 $15,000/ $30,000 $20,000/ $40,000 $20,000/ $40,000