MD FLEX HMO
ASSOCIATION PLAN #1
SMART DENT AND VISION
In Network - $20 Office Visit Copay
$125 per day/$500 max hospital copay
RX - $7/$15/$35 Non Formulary
|
Single |
2 Party |
Family |
| 3 Tier |
$324 |
$647 |
$911 |
| 2 Tier |
$324 |
N/A |
$886 |
|
MD FLEX POS
ASSOCIATION PLAN #2
SMART DENT AND VISION
In Network - $20 Office Visit Copay
$125 per day/$500 max hospital copay
RX - $10/$25/50% Non Formulary
|
Single |
2 Party |
Family |
| 3 Tier |
$415 |
$833 |
$1,173 |
| 2 Tier |
$415 |
N/A |
$1,141 |
|
| "FLEX NETWORK" |
"FLEX NETWORK" |
MD FLEX POS
ASSOCIATION PLAN #3
SMART DENT AND VISION
In Network - $20 Office Visit Copay
No hospital copay
Out of Network - $500/$1000 Cal/Yr.
80/20% Coinsurance Max. $2,500/5,000 out of pocket
RX - $10/$25/50% Non Formulary
|
Single |
2 Party |
Family |
| 3 Tier |
$427 |
$859 |
$1,210 |
| 2 Tier |
$427 |
N/A |
$1,176 |
|
MD FLEX VALUE
ASSOCIATION PLAN #4
SMART DENT AND VISION
In Network - $20 Office Visit Copay
$125 per day/$500 max hospital copay
RX - $7 Generic / Brand Discount
|
Single |
2 Party |
Family |
| 3 Tier |
$283 |
$563 |
$792 |
| 2 Tier |
$283 |
N/A |
$770 |
|
| "FLEX NETWORK" |
"FLEX NETWORK" |
MD HMO FOCUS
ASSOCIATION PLAN #5
SMART DENT AND VISION
In Network - $20 Office Visit Copay
$125 per day/$500 max hospital copay
RX - $7 Generic / Brand Discount
|
Single |
2 Party |
Family |
| 3 Tier |
$251 |
$499 |
$701 |
| 2 Tier |
$251 |
N/A |
$682 |
|
MD FOCUS HMO
ASSOCIATION PLAN #6
SMART DENT AND VISION
In Network - $20 Office Visit Copay
$125 per day/$500 max hospital copay
RX - $10/$25/50% Non Formulary
|
Single |
2 Party |
Family |
| 3 Tier |
$284 |
$565 |
$795 |
| 2 Tier |
$284 |
N/A |
$773 |
|
| "FOCUS
NETWORK" |
"FOCUS
NETWORK" |
