Connect Silver 5000 Indiv Med Deductible – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $60 copay
Urgent care visit: $35 copay

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Description

Health Care Plan Details

Network type HMO
Deductible Success

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Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $60 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $35 copay
Emergency room $2,000 copay after deductible
Ambulance 40% coinsurance after deductible
Hospital stay (facility) 40% coinsurance after deductible
Hospital stay (physician) 40% coinsurance after deductible
Outpatient procedure (facility) 40% coinsurance after deductible
Outpatient procedure (physician) 40% coinsurance after deductible
Physical rehabilitation 40% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 40% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic No charge
Brand $100 copay
Non-preferred Brand 50% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays 40% coinsurance after deductible
Imaging (CT/PET/MRI) 40% coinsurance after deductible
Blood work 40% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 40% coinsurance after deductible
Psychiatric hospital stay 40% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-il-944529-s-connect5000.pdf
Drug and medication plan formulary https://www.cigna.com/ifp-drug-lists
Search doctor list https://www.cigna.com/ifp-providers