UHC Silver-C $0 Ded ($0 PCP, $2 Tier 2 Rx, No Referrals) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: 25% coinsurance
Urgent care visit: $50 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $1,100 per person $2,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | 25% coinsurance |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay |
| Emergency room | 25% coinsurance |
| Ambulance | 25% coinsurance |
| Hospital stay (facility) | 25% coinsurance |
| Hospital stay (physician) | 25% coinsurance |
| Outpatient procedure (facility) | 25% coinsurance |
| Outpatient procedure (physician) | 25% coinsurance |
| Physical rehabilitation | 25% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 25% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $2 copay |
| Brand | $45 copay |
| Non-preferred Brand | 40% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 25% coinsurance |
| Imaging (CT/PET/MRI) | 25% coinsurance |
| Blood work | $5 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 25% coinsurance |
| Psychiatric hospital stay | 25% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://www.uhc.com/ifp/sbc.72375MD0070035-06.en.2024 |
| Drug and medication plan formulary | https://www.uhc.com/xmddruglist2024 |
| Search doctor list | https://www.uhc.com/xmddocfindoa2024 |
