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.

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