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WebA: The plan is a 90/10 plan with a total maximum out-of-pocket cost per year of $2,400 per family, composed of $1,600 per family ($800 per individual) in medical costs and $800 per family in prescription drug co-payments. There is a $250 per individual deductible that also counts toward the maximum out-of-pocket cost. There is no monthly premium. WebClick Here. This is a service provided to Payors and Providers that participate in the HealthSmart Preferred Care network. The Online Claims Status is a feature only available … penn state medical nyes rd