Molina Healthcare Gold Plan


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Confident Care Gold

Services Gold Plan 1
Value Basics
Teladoc Virtual Care Visits 24/7/365FREE
Annual Wellness Visit – AdultsFREE
Routine Preventive Screenings – Children & Adults FREE
Routine Vision Exams & eyewear for Children (0-18) FREE
Preventive Prescription Drugs FREE
24 Hour Nurse Line FREE
Urgent Care at Same Cost as Primary Physician VisitYES
Plan Options with Adult Vision ServicesYES
Benefit & Cost Share Highlights
Deductible (Ind/Fam)$2,100 / $4,200
Out-of-Pocket Max (Ind/Fam)$8,550 / $17,100
Drug Deductible (Ind/Fam)Combined Med/Rx
Rx Tiers 3&4 Only
Emergency Room Services20% after ded
Hospital / Facility Services
Inpatient Hospital20% after ded
Skilled Nursing Facility Services20% after ded
Hospital Physician Services20% after ded
Outpatient Surgery Services20% after ded
Outpatient Services
Primary & Urgent Care Services$10
Specialist Services$50
Mental/Behavioral Health Services$10
Imaging & Specialized Radiology20% after ded
Rehabilitative Services -ST, OT, PT $50
Routine Laboratory Services $15
Routine X-Ray & Diagnostic Services20% after ded
Prescription Drugs
Tier 1 – Preferred Generic Drugs$10
Tier 2 – Preferred Brand Drugs$50
Tier 3 – Non-Pref Brand & Generic Drugs30% after ded
Tier 4 – Specialty Drugs 30% after ded