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AvMed Open Access HMO

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Plan Name Deductible Description Summary of Benefit Design
HM-OA-3795 0 No Deductible, Co-pay Only Basic Option $45/$500Day; $10/30/50/75 OC
HM-OA-3796 0 No Deductible, Co-pay Only Basic Option $45/$250Day; $10/30/50/75 OC
HM-OA-3797 0 No Deductible, Co-pay Only Basic Option $45/$500Admit; $10/30/50/75 OC
HM-OA-3278 250 Deductible, Co-pay and Coinsurance Open Access HMO $20 / $250 / 10%; Rx $10/25/40/75 OC
HM-OA-3794 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-3794 - Open Access HMO $25/$500/$$2,500/20%; RX$10/$30/$50/$75 w/OC
HM-OA-3798 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-3798 - Open Access HMO $15/$500/$1500/20%; RX$10/$30/$50/$75 w/OC
HM-OA-4078 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-4078 - Open Access HMO $25/$500; RX$20/$40/$60/$75 w/ OC
HM-OA-5054 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5054 - Open Access HMO 15/500/1500/20%; RX$20/$40/$60/$75 w/ OC
HM-OA-5055 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5055 - Open Access HMO 20/500/1500/20%; RX$20/$40/$60/$75 w/ OC
HM-OA-5056 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5056 - Open Access HMO 30/500/1500/20%; RX$10/$30/$50/$75 w/OC
HM-OA-5057 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5057 - Open Access HMO 50/500/1500/20%; RX$10/$30/$50/$75 w/OC
HM-OA-5057B 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5057B - Open Access HMO 50/500/1500/20%; RX$20/$40/$60/$75 w/ OC
HM-OA-5058 500 Deductible, Co-pay, Coinsurance applies to DME and Diagnostic Tests HM-OA-5058 - Open Access HMO 25/500/2500/20%; RX$20/$40/$60/$75 w/ OC
HM-OA-5183 500 First dollar coverage for office visits and urgent care, 100% after deductible all other services Open Access HMO 25/500-08; RX$10/$30/$50/$75 w/OC
HM-OA-3279 750 Deductible, Co-pay and Coinsurance Open Access HMO $25 / $750 / 20%; Rx $20/35/50/75 OC
HM-OA-3280 1000 Deductible, Co-pay and Coinsurance Open Access HMO $30 / $1,000 / 20%; Rx $20/35/50/75 OC
HM-OA-5062 1000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5062 - Open Access HMO 25/1000/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5184 1000 First dollar coverage for office visits and urgent care, 100% after deductible all other services Open Access HMO 25/1000-08; RX$20/$40/$60/$75 w/ OC
HM-OA-5477 1250 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5477 - Open Access HMO 25/1250/1500; RX$20/$40/$60/$75 w/ OC
HD-OA-3688 1500 Copay only after deductible is met, HSA-qualified HDHP 1A; Rx $10/20/30/75 OC
HD-OA-3689 1500 100% after deductible is met, HSA-qualified HDHP 1B; Rx - No Charge after Ded
HM-OA-5063 1500 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5063 - Open Access HMO 25/1500/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5185 1500 First dollar coverage for office visits and urgent care, 100% after deductible all other services Open Access HMO 25/1500-08; RX$20/$40/$60/$75 w/ OC
HD-OA-5275 1750 Co-pay only after deductible is met, HSA-qualified AV-SG-HDHP-1F-09; Rx $10/20/30/75 OC
HD-OA-5276 1750 100% after deductible is met, HSA-qualified AV-SG-HDHP-1G-09; RX - No Charge after Ded
CD-OA-3701 2000 10% Coinsurance after deductible is met CDHP 1C; Rx $15/30/50/75 OC
HD-OA-3691 2000 20% Coinsurance after Deductible is met, HSA-qualified HDHP 1D; Rx $10/20/30/75 OC
HM-OA-5193 2000 First dollar coverage for office visits, co-pay for Office Visits/Urgent Care/Rx. All other $0 after deductible HM-OA-5193 - Open Access HMO 25/2000; RX$20/40/60//75 with OC
HM-OA-5478 2000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5478 - Open Access HMO 25/2000/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5059 2500 First dollar coverage for office visits and urgent care, 100% after deductible all other services HM-OA-5059 -Open Access HMO 25/2500; RX$20/$50/$75/$100 w/ OC
HM-OA-5064 2500 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5064 - Open Access HMO 25/2500/1500; RX$20/$40/$60/$75 w/ OC
HD-OA-3690 3000 100% after deductible is met, HSA-qualified HDHP 1C; Rx - No Charge after Ded
HM-OA-5479 3000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5479 - Open Access HMO 25/3000/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5480 3500 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5480 - Open Access HMO 25/3500/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5481 4000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5481 - Open Access HMO 25/4000/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5482 4500 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5482 - Open Access HMO 25/4500/1500; RX$20/$40/$60/$75 w/ OC
HD-OA-5187 5000 100% after deductible is met, HSA-qualified HDHP-1E-08; Rx - No Charge after Ded
HM-OA-5060 5000 First dollar coverage for office visits and urgent care, 100% after deductible all other services HM-OA-5060 - Open Access HMO 25/5000; RX$20/$50/$75/$100 w/ OC
HM-OA-5065 5000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5065 - Open Access HMO 25/5000/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5483 7500 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5483- Open Access HMO 25/7500/1500; RX$20/$40/$60/$75 w/ OC
HM-OA-5061 10000 First dollar coverage for office visits and urgent care, 100% after deductible all other services HM-OA-5061 - Open Access HMO 25/10000;RX $15 Generic Only
HM-OA-5066 10000 First dollar coverage for office visits, Co-pay only plan after meeting the Deductible HM-OA-5066 - Open Access HMO 25/10000/1500; RX$20/$40/$60/$75 w/ OC