US Platinum Pathway EPO 15 0 3500 by Empire
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Plan Information
- Plan Name
- US Platinum Pathway EPO 15 0 3500
- Insurance Company
- Empire
In Network Benefits
- Office Co-pay
- $15
- Specialist Co-pay
- $15
- Hospital Co-pay
- $250
- Emergency Room
- $150
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $5/$30/$60
- In-Network Deductible (single/family)
- $0
- In-Network Co-Insurance
- 0
- Max Out of Pocket (single/family)
- $3,500/$7,000
Out Of Network Benefits
- Co-Insurance
- N/A
- Deductible
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental; Adult Vision Only
- Renewal Date
- Annual
- HSA Eligible
- No
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