Plan Brochure
CommunityCare Silver L21 Select Plus
Plan Year:
2024
Metal Level:
Silver
Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.
Individual Deductible: | $3,500 |
Individual Out of Pocket Maximum: | $7,200 |
Office Visit Copay: | $35 |
Preferred Generics: | $15 |
Preferred Brand Name: | $45 |
Non-Preferred Brand Name: | $95* |
Individual Rx Deductible: | Integrated |
Preferred Specialty: | $300* |
Non-Preferred Specialty: | $350* |
First 3 telehealth visits at $0.
*Subject to the deductible.
Essential Benefits
All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health services
- Substance use disorder services
- Prescription drug coverage
- Rehabilitative and habilitative services and devices
- Preventative and wellness services
- Pediatric Services