UHC Silver-C Virtual Access (Unlimited $0 Virtual) – HMO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$150 per person $150 per person
Out-of-pocket max	$975 per person $1,950 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	10% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$60 copay
Emergency room	40% coinsurance after deductible
Ambulance	10% coinsurance after deductible
Hospital stay (facility)	10% coinsurance after deductible
Hospital stay (physician)	10% coinsurance after deductible
Outpatient procedure (facility)	10% coinsurance after deductible
Outpatient procedure (physician)	10% coinsurance after deductible
Physical rehabilitation	10% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	10% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$1 copay
Brand	$45 copay after deductible
Non-preferred Brand	40% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	10% coinsurance after deductible
Imaging (CT/PET/MRI)	10% coinsurance after deductible
Blood work	No charge

Mental and Psychiatric Health Care

Mental Health outpatient services	10% coinsurance after deductible
Psychiatric hospital stay	10% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.uhc.com/ifp/sbc.72375MD0070030-06.en.2024
Drug and medication plan formulary	https://www.uhc.com/xmddruglist2024
Search doctor list	https://www.uhc.com/xmddocfindvf2024