Plan Summary - AnyHealthInsurance.com

Individual HMO

Amounts shown for covered services are your share of costs In-Network Benefits
	Individual HMO
	QUOTE
Insurance Company
Plan Type - PPO \| HMO \| HSA	HMO
Annual Deductible	$0
Annual Out-Of-Pocket (includes Annual Deductible)	$3,000 individual; $6,000 family
Doctor Visit	$10 copay
Lifetime Maximum	Unlimited
Inpatient	20% coinsurance
Outpatient	20% coinsurance
Maternity	Office visits: $10 copay;Inpatient/Outpatient: 20% coinsurance
Emergency Services	$100 copay(waived if admitted) + 20% coinsurance
Ambulance	$50 copay, waived if admitted to hospital
X-Ray & Lab	No charge for office visit-related services
Annual Check up	$10 copay for specific health maintenance services
Pap Smear/Mammogram	$10 copay
Physical Therapy	Outpatient: $10 copay per visit; Inpatient: 20% coinsurance (up to 60 consecutive days following an illness or injury)
Acupuncture	Not covered
Chiropractic Care	Outpatient $10 copay; Inpatient 20% coinsurance (up to 60 consecutive days following an illness or injury)
Generic Rx	$10 copay
Brand Name Rx	$30 copay after $250 brand name deductible
Term Life Coverage	Optional
Dental	Optional
Vision	Not covered
Eligibility	Reside in California at least 3 months
Available Effective Date	Any Day
Plan Limitations And Restrictions	PDF
Insurance Company
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	Individual HMO