H5322 025 - Edit your h5322 025 form form online. Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more. Add your legally-binding signature. Draw or type your signature, upload a signature image, or capture it with your digital camera. Email, fax, or share your h5322 025 form form via URL.

 
Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. . Woofie

This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. We would like to show you a description here but the site won’t allow us. UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drugLearn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com The UnitedHealthcare Dual Complete (HMO D-SNP) (H5322 - 025) currently has 35,217 members. There are 259 members enrolled in this plan in Hood, Texas. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Sep 1, 2023 · UnitedHealthcare Dual Complete (HMO-POS D-SNP) You're viewing plan details for. 27053 Alamance County. Update your ZIP Code to view accurate plan details for your area. Monthly Premium. $ 0 - $ 38.40. Primary Care Provider. $ 0 copay - 20 % of the cost. Out-of-Pocket Maximum. Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. In-Network: Preventive Dental Services: $0.00 copay. This plan covers: 2 oral exam (s), 2 cleaning (s), 1 dental X-ray (s), 1 fluoride treatment (s) every year. Medicare Covered Dental: $0.00 copay. Comprehensive Dental Services: $0.00 copay. This plan covers up to a $4,500.00 allowance for covered comprehensive dental services every year. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium Apr 1, 2023 · -060 002 Cigna TotalCare (HMO D SNP) H4590-025-AARP Medicare Advantage SecureHorizons (HMO) H4513-061-002 -Cigna Preferred Medicare (HMO) H4590-033- UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711. Number of Members enrolled in this plan in (H5322 - 025): 48,964 members : Plan’s Summary Star Rating: 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details H5322 - 025 - 0. 1-866-944-4983 TTY users 711. — This plan information is for research purposes only. — Click here to see plans for the current plan year. 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (HMO D-SNP) benefit details. Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H5322-025-0 in TX Plan Benefits Details 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. H5322 - 025 - 0. 1-866-944-4983 TTY users 711. — This plan information is for research purposes only. — Click here to see plans for the current plan year. 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (HMO D-SNP) benefit details. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. Number of Members enrolled in this plan in (H5322 - 025): 35,217 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drugJan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) H1416_2023_TN_SB_DSNP_104494E_M ©Wellcare 2023 TN3IMRSOB04494E_0285 2023 Summary of Benefits Tennessee Wellcare Dual Access (HMO D-SNP) H1416 | 035 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-025-000 no QMB card Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229012412Z UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical HHSC approved Medicare Advantage and Dual eligible Plans 01/01/2023-12/31/2023 Medicare Advantage Plan HHSC Contract Number CMS Code Plan ID Plan Name 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-025-000 no QMB card Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229012412Z Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage In-Network: Preventive Dental Services: $0.00 copay. This plan covers: 2 oral exam (s), 2 cleaning (s), 1 dental X-ray (s), 1 fluoride treatment (s) every year. Medicare Covered Dental: $0.00 copay. Comprehensive Dental Services: $0.00 copay. This plan covers up to a $4,500.00 allowance for covered comprehensive dental services every year. Jan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of Coverage (EOC) for complete list of covered services, limitations and exclusions.Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. H1416_2023_TN_SB_DSNP_104494E_M ©Wellcare 2023 TN3IMRSOB04494E_0285 2023 Summary of Benefits Tennessee Wellcare Dual Access (HMO D-SNP) H1416 | 035 A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000Number of Members enrolled in this plan in (H5322 - 025): 48,964 members : Plan’s Summary Star Rating: 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. Number of Members enrolled in this plan in (H5322 - 025): 48,964 members : Plan’s Summary Star Rating: 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium Edit your h5322 025 form form online. Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more. Add your legally-binding signature. Draw or type your signature, upload a signature image, or capture it with your digital camera. Email, fax, or share your h5322 025 form form via URL. UnitedHealthcare Dual Complete (H5322-025) • Submit claims to WellMed. WellMed will reimburse you for the member’s medical services. UnitedHealthcare will reimburse you for the applicable member cost s hare. 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical

H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com . Shout out my label that

h5322 025

VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details H5322-025-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical Number of Members enrolled in this plan in (H5322 - 025): 48,964 members : Plan’s Summary Star Rating: 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. Inpatient hospital-acute: In-network: $0 or $1,556 per stay $0 per day for days 91 and beyond Out-of-network: Not Applicable Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay Out-of-network: Not Applicable. Occupational therapy services: In-network: 0% or 20% coinsurance Out-of-network: No Data Physical therapy and speech and ... Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.Plan ID: H5322-028-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Ohio Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and ... Emergency care/Urgent care. • Emergency: $0 or $90 copay per visit (always covered) • Urgent care: $0 or $65 copay per visit (always covered) Inpatient hospital coverage. • In 2020 the amounts for each benefit period are $0 or: $1,408 deductible for days 1 through 60. $352 copay per day for days 61 through 90. Sep 1, 2023 · UnitedHealthcare Dual Complete (HMO-POS D-SNP) You're viewing plan details for. 27053 Alamance County. Update your ZIP Code to view accurate plan details for your area. Monthly Premium. $ 0 - $ 38.40. Primary Care Provider. $ 0 copay - 20 % of the cost. Out-of-Pocket Maximum. .

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