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BX Insurance Plan

Insurance Id: S0395106
Rx Bin: 610852
Rx Group: JD27
Group: FHP2022-12156

Deductible: $3250

Primary Care Visit: 30% after Deductible

Specialist Visit: 30% after Deductible

Mental Health Visit: 30% after Deductible

Urgent Care Visit: $75 Copay after Deductible

In-Patient Hospital: 30% after Deductible

Emergency Room: 30% after Deductible

VSP Vision: $0, 1 Exam per year

Effective Date: 01-01-2022