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
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 |