Catastrophic Minimum Coverage
Catastrophic coverage for eligible individuals
Eligibility Requirements
Minimum Coverage plans are only available to:
- Individuals under 30 years old
- Those with a certified hardship exemption
- Those who qualify for an affordability exemption
These plans cover essential health benefits and protect you from worst-case scenarios, but have higher out-of-pocket costs for routine care. Learn more about minimum coverage requirements
Cost Overview
Annual Deductible
$10,600
Out-of-Pocket Maximum
$10,600
Standardized Benefits
| Service | You Pay | Notes |
|---|---|---|
| Deductibles | ||
| Individual Deductible (Medical) | $10,600 | |
| Individual Deductible (Pharmacy) | Integrated with medical deductible | |
| Family Deductible (Medical) | $21,600 | |
| Family Deductible (Pharmacy) | Integrated with medical deductible | |
| Care Visits | ||
| Preventive Care | no charge | |
| Primary Care Visit | $0 | The first three non-preventive visits for any combination of Primary Care, Specialists, Therapy, Acupuncture, or Urgent Care are covered at no charge. The deductible will apply starting with the 4th visit. |
| Urgent Care Visit | $0 | The first three non-preventive visits for any combination of Primary Care, Specialists, Therapy, Acupuncture, or Urgent Care are covered at no charge. The deductible will apply starting with the 4th visit. |
| Specialty Care Visit | $0 | The first three non-preventive visits for any combination of Primary Care, Specialists, Therapy, Acupuncture, or Urgent Care are covered at no charge. The deductible will apply starting with the 4th visit. |
| Mental/Behavioral Health Visit | $0 | The first three non-preventive visits for any combination of Primary Care, Specialists, Therapy, Acupuncture, or Urgent Care are covered at no charge. The deductible will apply starting with the 4th visit. |
| Tests & Therapy | ||
| Other Therapy (PT/OT/Speech) | $0 | The first three non-preventive visits for any combination of Primary Care, Specialists, Therapy, Acupuncture, or Urgent Care are covered at no charge. The deductible will apply starting with the 4th visit. |
| Lab Testing | $0 | |
| X-rays & Diagnostic Imaging | $0 | |
| Advanced Imaging (CT/MRI) | $0 | |
| Hospital & Emergency | ||
| Outpatient Surgery | $0 | |
| Emergency Room | $0 | |
| Emergency Transport | $0 | |
| Prenatal/Postnatal Care | $0 | |
| Inpatient Hospital Stay | $0 | |
| Hospital Physician | $0 | |
| Prescription Drugs | ||
| Generic Drugs (Tier 1) | $0 | |
| Preferred Brand Drugs (Tier 2) | $0 | |
| Non-Preferred Brand Drugs (Tier 3) | $0 | |
| Specialty Drugs (Tier 4) | $0 | |
| Out of Pocket Maximums | ||
| Maximum Out of Pocket (Individual) | $10,600 | |
| Maximum Out of Pocket (Family) | $21,200 | |
Understanding Deductibles and Benefit Costs
Benefits in Orange are Subject to the Annual Deductible amounts listed above. You will pay the full cost for these services until the Deductible is met. Then you will pay the specified amount that is shown until the Annual Maximum Out-of-Pocket is met. The deductible counts toward the Maximum Out-Of-Pocket.
Copays in Black are NOT Subject to any Deductible and count towards the Annual Maximum Out-Of-Pocket. The Annual Out-Of-Pocket Maximum and Deductible amounts are always based on the Individual amount listed even under a family plan. Two or more people in the family have to reach the family amounts listed above in order for them to apply to the entire family.
Understanding Your Benefits
- Copay: A fixed amount you pay for a covered service.
- Coinsurance: Your share of costs after meeting your deductible (shown as a percentage).
- Deductible: The amount you pay before your insurance starts covering costs.
- Out-of-Pocket Maximum: The most you'll pay in a year for covered services.