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CDPHP Plans

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MVP - Hybrid (EPOc) - Click here for the detailed plan summary.
E4000051

This plan is an EPO (Exclusive Provider Organization) Hybrid (includes in network deductibles) with no out of network coverage & no referrals needed. There is a $1,000 (single) $2,500 (family) in network deductible with an 80% coinsurance. It has a $40 primary & specialist office visit co-pay. Inpatient hospital you must meet deductible & coinsurance and a $200 co-pay for an emergency room visit. The Prescription coverage is $10/$30/$50 with no deductible.
 

Monthly

Monthly

Quarterly

Small Group

Sole Proprietor

Sole Proprietor

Employee $417.76

$478.93

$1436.79

Family $1057.06

$1226.15

$3678.45

  Plan Selection

Plan Selection

Plan Selection

  Instructions

Instructions

Instructions

  Application

Application

Application

  Student Verification Form
  Rx Form for Plan E4000051

MVP - (EPO)  Click here for the detailed plan summary.
E4000050

This plan is an EPO (Exclusive Provider Organization) with no out of network coverage & no referrals needed. There is a $40 primary & specialist office visit co-pay. Inpatient hospital $500 and a $100 co-pay for an emergency room visit. The Prescription coverage is 10/30/50 with no deductible.
 

Monthly

Monthly

Quarterly

Small Group

Sole Proprietor

Sole Proprietor

Employee
$501.86

$575.65

$1,726.95

Family $1,287.31

$1,478.90

$4,436.70

  Plan Selection

Plan Selection

Plan Selection

  Instructions

Instructions

Instructions

  Application

Application

Application

  Student Verification Form
  Rx Form for Plan E4000050

MVP - HMO  - Click here for the detailed plan summary.
H2540313

This plan is an HMO with no out of network coverage & are referrals needed. It has a $25 primary & $40 specialist office visit co-pay. The inpatient hospital is a $500 co-pay and a $100 co-pay for an emergency room visit. The Prescription coverage is 10/30/50 with $100 deductible.
 

Monthly

Monthly

Quarterly

Small Group

Sole Proprietor

Sole Proprietor

Employee $499.96

$573.46

$1,720.38

Family $1277.07

$1467.14

$4,401.42

  Plan Selection

Plan Selection

Plan Selection

  Instructions

Instructions

Instructions

  Application

Application

Application

  Student Verification Form
  Rx Form for Plan H2540313

 

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