Board Of Aldermen - Agenda - 12/8/2020 - P88
HMO Co-pays and Deductibles:
The HMO Plan shall have the following co-pays and deductibles:
(a) Twenty Dollars ($20.00) per medical visit;
(b) One Hundred Dollars ($100.00) per emergency room visit;
(c) Two Hundred Fifty Dollars ($250.00) Per Person, Five Hundred Dollars
($500.00) Per 2 Person/Family Inpatient/Outpatient Facility Deductible; and
(d) Three Tier Pharmacy Benefit of $5/$15/$35 ($5/$30/$70 Mail Order).
Effective July 1, 2021, the HMO Plan shall have the following co-pays and deductibles: