Silver AV94 1809 ($0 Deductible, $800 Out of Pocket Maximum, Open Access) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: 35% coinsurance
Specialist visit: 35% coinsurance
Urgent care visit: 35% coinsurance
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | Success
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| Out-of-pocket max | $800 per person $1,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | 35% coinsurance |
| Specialist visit | 35% coinsurance |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 35% coinsurance |
| Emergency room | 35% coinsurance |
| Ambulance | 35% coinsurance |
| Hospital stay (facility) | 35% coinsurance |
| Hospital stay (physician) | 35% coinsurance |
| Outpatient procedure (facility) | 35% coinsurance |
| Outpatient procedure (physician) | 35% coinsurance |
| Physical rehabilitation | 35% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 35% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | 30% coinsurance |
| Brand | 30% coinsurance |
| Non-preferred Brand | 30% coinsurance |
| Specialty | 30% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 35% coinsurance |
| Imaging (CT/PET/MRI) | 35% coinsurance |
| Blood work | 35% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 35% coinsurance |
| Psychiatric hospital stay | 35% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://hf.org/2024_sbc_1809.pdf |
| Drug and medication plan formulary | https://hf.org/MP_formulary_2024 |
| Search doctor list | https://hf.org/MP_directory_2024 |
