You can select this plan if you live in San Diego County. This plan exclusively covers you when you access SIMNSA Premier Access HMO providers. The plan covers many health services at 100%. Some services require a small copayment. You are not required to choose a primary care physician to manage your care. Except in the case of an emergency, you’ll pay the full price for any care you receive from a non-SIMNSA doctor or facility.
| 2025 SIMNSA BAJA CA PREMIER ACCESS HMO PLAN HIGHLIGHTS | |
|---|---|
| Provider Network | SIMNSA Health Plan provider network |
| Primary Care Physician (PCP) to manage care | Not required |
| Referrals needed to see a specialist | Not required |
| Calendar Year Deductible | N/A |
| Health Savings Account (HSA) | No |
| Coinsurance (You Pay) After Meeting Deductible | None |
| Calendar Year Out-of-Pocket Maximum | $6,350 per individual/$12,700 per family |
| Preventive Care | Covered in full (calendar year deductible waived) |
| Office Visit (You Pay) | $5 copay |
| Hospitalization | Covered in full |
| Pharmacy Retail (30-day supply) |
Network pharmacy: specified preventive drugs—100% covered; generic—$5 copay; brand formulary—$5 copay; brand non-formulary—$5 copay; specialty drugs-$5 copay
|
| Pharmacy Mail Services (up to 90-day supply) |
Network pharmacy: specified preventive drugs—N/A; generic—N/A; brand formulary—N/A; brand non-formulary—N/A
|