Please help me evaluate this plan’s Summary of Benefits

Location: California

Summary of Benefits:

My new employer offers two HMO plans and one plan called Health Net which offers three tiers: HMO, PPO, and out-of-network. My current primary care doctor is not a part of any of these plans so I'd have to choose Health Net and go out-of-network to continue to see them. My PCP has been monitoring me long-term on a medication that is prescribed off label and I do not want to start the process over with a new provider.

Reviewing the Summary of Benefits, it seems like the Health Net plan will cover drugs prescribed by an out-of-network provider with a small copay ($5/$15/$30), even ones that are not on the plan's formulary (I'm assuming that's what "non-preferred brand drugs" means?).

Second, it looks like there is an annual deductible of $200 for out-of-network expenses. Does that mean I pay for office visits out of pocket, and once I hit $200, the coinsurance will kick in?

The out of pocket office visits are a minor concern as I'm ok with paying that, but the medication I'm on costs hundreds of dollars per month if not covered by insurance. I just wanted to make sure my interpretation of the plan was correct before switching to it. Thanks in advance.

submitted by /u/invisiblemonsters3

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