2018 Individual Off-Marketplace Plans

Platinum:

PHP Platinum 250

  • Deductible: $250/$500
  • Coinsurance: 80%
  • Maximum out-of-pocket: $1,500/$3,000
  • Office Visit/FastCare: $20 
  • Specialist: $35
  • Urgent Care: $50
  • ER: $150
  • Rx: $10/$40/$80/$150
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 
HMO Network: Summary of Benefits and Coverage; Certificate of Coverage


PHP Platinum 500-100% 

  • Deductible: $500/$1,000
  • Coinsurance: 100%
  • Maximum out-of-pocket: $2,200/$4,400
  • Office Visit/FastCare: $20 
  • Specialist: $35
  • Urgent Care: $50
  • ER: $200
  • Rx: $10/$40/$80/$150

Gold:

PHP Gold 500

  • Deductible: $500/$1,000
  • Coinsurance: 80%
  • Maximum out-of-pocket: $5,200/$10,400
  • Office Visit/FastCare: $30
  • Specialist: $60
  • Urgent Care: $50
  • ER: $325 after deductible
  • Rx: $20/$50/$80/$150

PHP Gold 500 Basic

  • Deductible: $500/$1,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $25
  • Specialist: $50
  • Urgent Care: $50
  • ER: $350
  • Rx: $20/$50/$80/$150

PHP Gold 1000

  • Deductible: $1,000/$2,000
  • Coinsurance: 80%
  • Maximum out-of-pocket: $5,000/$10,000
  • Office Visit/FastCare: $25
  • Specialist: $50
  • Urgent Care: $50
  • ER: $250
  • Rx: $20/$50/$80/$150

PHP Gold 1400 HSA

  • Deductible: $1,400/$2,800
  • Coinsurance: 100%
  • Maximum out-of-pocket: $4,000/$6,650
  • Office Visit/FastCare: 0% after deductible
  • Specialist: 0% after deductible
  • Urgent Care: 0% after deductible
  • ER: 0% after deductible
  • Rx: $20/$50/$80/$150 after deductible
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 

Sparrow PHP Gold 1400

  • Deductible: $1,400/$2,800
  • Coinsurance: 80%
  • Maximum out-of-pocket: $5,000/$10,000
  • Office Visit/FastCare: $20
  • Specialist: $50
  • Urgent Care: $60
  • ER: 20% after deductible
  • Rx: 10/40/75/30%
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 

PHP Gold 2000

  • Deductible: $2,000/$4,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $6,800/$13,600
  • Office Visit/FastCare: $30
  • Specialist: $60
  • Urgent Care: $50
  • ER: $350
  • Rx: $20/$50/$80/$150

Silver:

PHP Silver 2000

  • Deductible: $2,000/$4,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $40
  • Specialist: $65 after deductible
  • Urgent Care: $50
  • ER: $450 after deductible
  • Rx: $30/$65/$150/$200

PHP Silver 2500

  • Deductible: $2,500/$4,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $40
  • Specialist: $75
  • Urgent Care: $50
  • ER: $450 after deductible
  • Rx: $30/$75/$200/$250

Sparrow PHP Silver HDHP

  • Deductible: $2,700/$3,400
  • Coinsurance: 80%
  • Maximum out-of-pocket: $4,000/$8,000
  • Office Visit/FastCare: 20% after deductible
  • Specialist: 20% after deductible
  • Urgent Care: 20% after deductible
  • ER: 20% after deductible
  • Rx: $20/$50/$80/$120
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 

PHP Silver 3000

  • Deductible: $3,000/$6,000
  • Coinsurance: 60%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $40
  • Specialist: $60
  • Urgent Care: $50
  • ER: $425 after deductible
  • Rx: $30/$65/$150/$200

PHP Silver 3500

  • Deductible: $3,500/$7,000 (500 RX deductible)
  • Coinsurance: 80%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $30
  • Specialist: $65
  • Urgent Care: $75
  • ER: 20% after deductible
  • Rx: 15/50/100/140%
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 

PHP Silver 4000

  • Deductible: $4,000/$8,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $35
  • Specialist: $60
  • Urgent Care: $50
  • ER: $425 after deductible
  • Rx: $30/$65/$150/$200

Sparrow PHP Silver 5000

  • Deductible: $5,000/$10,000
  • Coinsurance: 70%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $40
  • Specialist: $60
  • Urgent Care: $50
  • ER: $425 
  • Rx: $30/$65/$120/$200

Sparrow PHP Silver 7000

  • Deductible: $7,000/$14,000
  • Coinsurance: 60%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $30
  • Specialist: $60
  • Urgent Care: $50
  • ER: $420 after deductible
  • Rx: $30/$65/$150/$200

Bronze:

PHP Bronze 5500 HSA

  • Deductible: $5,500/$11,000
  • Coinsurance: 60%
  • Maximum out-of-pocket: $6,500/$13,000
  • Office Visit/FastCare: 40% after deductible
  • Specialist: 40% after deductible
  • Urgent Care: 40% after deductible
  • ER: 40% after deductible
  • Rx: $40/$80/$160/$200 after deductible

Sparrow PHP Bronze 6000 HSA

  • Deductible: $6,000/$12,000
  • Coinsurance: 100%
  • Maximum out-of-pocket: $6,000/$12,000
  • Office Visit/FastCare: 0% after deductible
  • Specialist: 0% after deductible
  • Urgent Care: 00% after deductible
  • ER: 0% after deductible
  • Rx: 0% after deductible

PHP Bronze 6550 HSA

  • Deductible: $6,550/$13,100
  • Coinsurance: 100%
  • Maximum out-of-pocket: $6,550/$13,100
  • Office Visit/FastCare: 0% after deductible
  • Specialist: 0% after deductible
  • Urgent Care: 00% after deductible
  • ER: 0% after deductible
  • Rx: 0% after deductible
Exclusive Network: Summary of Benefits and Coverage; Certificate of Coverage 
HMO Network: Summary of Benefits and Coverage; Certificate of Coverage

Sparrow PHP Bronze 6650

  • Deductible: $6,650/$13,300
  • Coinsurance: 60%
  • Maximum out-of-pocket: $7,350/$14,700
  • Office Visit/FastCare: $35
  • Specialist: $75
  • Urgent Care: $75
  • ER: 40% after deductible
  • Rx: 30%/35%/40%/45%

Catastrophic:

Sparrow PHP Healthy HMO

  • Deductible: $7,350/$14,700
  • Coinsurance: 100%
  • Maximum Out-of-Pocket: $7,350/$14,700
  • Office Visit/FastCare: 0%
  • Specialist: 0% after deductible
  • Urgent Care: 0% after deductible
  • ER: 0% after deductible
  • Rx: 0% after deductible