Ambetter Health

Ambetter Essential Care 1 + Vision + Adult Dental

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Summary Of Benefits

Plan Overview

Medical Deductible	Individual: $8,600 Family: $17,200 Per Person: $8,600
Prescription Drug Deductible	Individual: Included in Deductible Family: Included in Deductible Per Person: Included in Deductible
Medical Out-of-Pocket Maximum	Individual: $8,600 Family: $17,200 Per Person: $8,600
Drug Out-of-Pocket Maximum	Individual: Included in Deductible Family: Included in Deductible Per Person: Included in Deductible

Office Visit

Primary Doctor	Standard: No Charge after deductible
Specialist	Standard: No Charge after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: No Charge after deductible
Non Preferred Brand Drugs	Standard: No Charge after deductible
Generic Drugs	Standard: $25
Specialty Drugs	Standard: No Charge after deductible

Inpatient Coverage

Hospital Services	Standard: No Charge after deductible
Inpatient Services	Standard: No Charge after deductible

Emergency and Urgent Care

Emergency Room

Standard: No Charge after deductible

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