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Benefits + Costs by Plan Level

When you get services, you may have to pay out-of-pocket costs.

View the Benefit and Cost-sharing Summary for your plan level. These summaries give you information about the costs you have to pay for covered services.

Please note: For certain services, your provider will need to ask us for a prior authorization before sending you to get those services. Your provider knows when and how to ask us for prior authorization if it is required. 

2019 Benefit and Cost-sharing Summaries:

Direct ConnectorCare Plan Type I
Direct ConnectorCare Plan Type II
Direct ConnectorCare Plan Type III
Direct Platinum
Direct Gold 1000
Direct Gold 2000
Direct Silver 2000
Direct Silver 2000 II
Direct Silver 2500 with Co-insurance
Direct Bronze 2750
Direct Bronze 3500 with Co-insurance
Direct Catastrophic

 


To view the 2018 Summaries of Benefits and Coverage, visit our Forms + Documents page. 

For a full list of covered benefits, see the covered services section of the Member Handbook 2019.

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