For a better experience on eHealth.com, update your IE browser or use a different browser. Update IE

Compare health insurance quotes.

Find affordable health insurance and apply online.

Find Plans Now
We're sorry.This plan is no longer available.To see plans that are available and get free quotes,enter your ZIP Code above.
Plan Type HMO
Metal Level Silver
Office Visit for Primary Doctor
Find Doctors
$30 Copay
Office Visit for Specialist $60 Copay
Office Visit for Other Practitioner (Nurse, Physician Assistant) $30 Copay
Annual Deductible Individual: $2,500
Separate Prescription Drugs Deductible $250 Individual
$500 Family
applies to
Brand & Specialty
Coinsurance 30%
Retail Prescription Drugs Preventive Generic: (KP/Affiliate) $5/$15 Copay; Preferred Generic: (KP/Affiliate) $15/$25 Copay; Preferred Brand: (KP/Affiliate) $45/$55 Copay; Specialty: 50% Coinsurance
Annual Out-of-Pocket Limit Individual: $6,350
Includes deductible
Lifetime Maximum Unlimited
Health Savings Account (HSA) Eligible No
Out-of-Network Coverage Emergency Care Only 
Out-of-Country Coverage Emergency Care Only.
Office Visit
Primary Care Physician Required Yes
Specialist Referrals Required Yes
Preventive Care Coverage
Periodic Health Exam No Charge
Periodic OB-GYN Exam No Charge
Well Baby Care No Charge
Emergency and Urgent Care
Emergency Room $400 Copay
Emergency Ambulance Services 30% Coinsurance after deductible
Urgent Care Facility $100 Copay
Prescription Drug Coverage
Retail Prescription Drugs Preventive Generic: (KP/Affiliate) $5/$15 Copay; Preferred Generic: (KP/Affiliate) $15/$25 Copay; Preferred Brand: (KP/Affiliate) $45/$55 Copay; Specialty: 50% Coinsurance
Separate Prescription Drugs Deductible $250 Individual
$500 Family
applies to
Brand & Specialty
Mail Order Prescription Drugs Preventive Generic: $10 Copay; Preferred Generic: $30 Copay; Preferred Brand: $90 Copay; Specialty: 50% Coinsurance
Mail Order Supply 90-Day supply
Outpatient Coverage
Outpatient Surgery 30% Coinsurance after deductible
Outpatient Lab/X-Ray 30% Coinsurance after deductible
Imaging (CT and PET scans, MRIs) $300 Copay
Outpatient Mental Health $30 Copay
Outpatient Substance Abuse $30 Copay
Outpatient Rehabilitation Services (PT, OT, ST) 30% Coinsurance after deductible; PT/OT: Combined 20 Visits Per Year, ST: 20 Visits Per Year
Inpatient Coverage
Hospitalization 30% Coinsurance after deductible
Skilled Nursing Facility 30% Coinsurance after deductible, 30 Days per Year
Inpatient Mental Health 30% Coinsurance after deductible
Inpatient Substance Abuse 30% Coinsurance after deductible
Home Healthcare 30% Coinsurance after deductible, 120 Visit(s) per Year
Maternity Coverage
Pre & Postnatal Office Visit No Charge
Labor & Delivery Hospital Stay 30% Coinsurance after deductible
Pediatric Services
Dental Checkup for Children Not Covered
Vision Screening for Children $30 Copay, 1 Visit(s) per Year
Eye Glasses for Children No Charge, 1 Item(s) per Year
Major Dental Coverage (Pediatric) Not Covered
Additional Coverage
Chiropractic Coverage $60 Copay, 20 Visit(s) per Year
Durable Medical Equipment 30% Coinsurance after deductible
Hospice No Charge
Major Dental Coverage (Adult) Not Covered
Vision Coverage (Adult) $30 Copay, 1 Visit(s) per Year
Out-of-Network Coverage
Out-of-Network Authorization Required N/A
Out-of-Network Annual Deductible N/A
Out-of-Network Annual Coinsurance N/A
Out-of-Network Annual Out-of-Pocket Limit N/A
Additional Information
A.M. Best Rating NR-5 as of 06/23/2010
Electronic Signature for Application Available Yes
Details and documents about this plan
View Plan Brochure Summary of Benefits & Coverage

The Summary of Benefits & Coverage form pertains to the coverage provided by a particular health insurance plan. If you select certain optional benefits while applying for this health insurance plan, a modified Summary of Benefits & Coverage may be available that reflects the optional benefits that you selected. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.

Customer reviews

Important notices and disclaimers

  • The benefits matrix is a summary for informational purposes only. Review the evidence of coverage and insurance policy (plan contract) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
  • The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
  • The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
  • Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
  • The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
  • The Summary of Benefits & Coverage form pertains to the coverage provided by a particular health insurance plan. If you select certain optional benefits while applying for this health insurance plan, a modified Summary of Benefits & Coverage may be available that reflects the optional benefits that you selected. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.