The Basic plan is designed for people who use health care infrequently and have enough savings to pay a higher deductible and coinsurance if they need an unexpected surgery or hospital visit. For example, if you are generally healthy and only see a doctor for the occasional sore throat, this plan might be a good option for you. You’ll pay lower premiums, but your costs will be higher when you need care.
Each person has an individual $5,000 in-network deductible. When a family member has spent the individual deductible amount, they begin to pay coinsurance for in-network services. Meanwhile, if other family members need care, they must meet their individual deductibles unless the family deductible of $10,000 has already been met (for a family with three or more members). Your copays for office visits, urgent care clinics (when applicable), Telehealth and prescription drugs do not count toward your deductible. In network services do not apply to your out-of-network deductible and out-of-network services do not apply toward your in-network deductible.
The Basic plan offers free preventive care and copays for visits to in-network doctor’s offices (excluding specialists) and some urgent care clinics. You also pay copays or coinsurance for prescription drugs. For all other care, you must meet your deductible, then you’ll pay 30% coinsurance for in-network. If you reach the out-of-pocket maximum, you won’t pay anything for covered services for the rest of the year.
*In-network and out-of-network deductibles are separate. Only in-network services apply toward your in-network deductible, and only out-of-network services apply to your out-of-network deductible.
**If you (as a plan participant) receive a brand name drug in place of a generic in either of the situations below, the plan will only cover the cost of the generic drug, requiring you to pay the cost difference between the generic drug and the brand name drug: