CareSource West Virginia Co.

CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $5,100.00 Family: $10,200 Per Person: $5,100
Combined Medical and Drug Out of Pocket Maximum	Individual: $7,500.00 Family: $15,000 Per Person: $7,500

Office Visit

Primary Doctor	CoPay: $25.00 CoInsurance: Not Applicable Covered: Covered
Specialist	CoPay: $60.00 CoInsurance: Not Applicable Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: $50.00 CoInsurance: Not Applicable Covered: Covered
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 20.00% Coinsurance after deductible Covered: Covered
Generic Drugs	CoPay: $20.00 CoInsurance: Not Applicable Covered: Covered
Specialty Drugs	CoPay: Not Applicable CoInsurance: 45.00% Coinsurance after deductible Covered: Covered

Inpatient Coverage

Hospital Services	CoPay: $500.00 Copay per Stay after deductible CoInsurance: Not Applicable Covered: Covered
Inpatient Services	CoPay: $500.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: $400.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Emergency room copay or coinsurance is waived if you are admitted to the hospital directly from the Emergency Department.
Urgent Care Facility	CoPay: $75.00 CoInsurance: Not Applicable Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: $500.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Pre and Postnatal Office Visit	CoPay: $60.00 CoInsurance: Not Applicable Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: $0.00
CoInsurance: 0.00%
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	CoPay: $0.00 CoInsurance: Not Applicable Covered: Covered Limit Quantity: 2 Limit Unit : Visit(s) per Year
Routine Dental Checkups for Adults	CoPay: $0.00 CoInsurance: Not Applicable Covered: Covered Limit Quantity: 2 Limit Unit : Visit(s) per Year Benefit Explanation: $1,000 Annual limit combined for all Adult Dental Services. See plan documents for details on benefit limits.

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

Sick With a Cold, Flu, or Allergies? Symptoms + Tips to Get Well

Is it a cold, flu, or allergies? You’re feeling pretty lousy. You’ve got sniffles,…Read More

Read More

You have health insurance, but what about vision and dental insurance?

It’s important to have insurance for health, dental, and vision. But does one plan…Read More

Read More

What Does Basic Health Insurance Cost?

Shopping for healthcare can be time-consuming and feel overwhelming. And one frustrating part can…Read More

Read More