KP MD Silver Virtual Forward 750/CSR – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: first 1 visit(s) $0 then $35 copay after deductible
Specialist visit: first 1 visit(s) $0 then $55 copay after deductible
Urgent care visit: first 1 visit(s) $0 then $55 copay after deductible
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $750 per person $750 per person |
| Out-of-pocket max | $2,100 per person $4,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | first 1 visit(s) $0 then $35 copay after deductible |
| Specialist visit | first 1 visit(s) $0 then $55 copay after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | first 1 visit(s) $0 then $55 copay after deductible |
| Emergency room | 10% after deductible |
| Ambulance | No charge after deductible |
| Hospital stay (facility) | 10% after deductible |
| Hospital stay (physician) | 10% after deductible |
| Outpatient procedure (facility) | 10% after deductible |
| Outpatient procedure (physician) | 10% after deductible |
| Physical rehabilitation | $55 copay after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 10% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $30 copay after deductible |
| Non-preferred Brand | 20% after deductible |
| Specialty | 20% after deductible, up to $150 copay, 20% after deductible, up to $150 |
Lab Tests and Diagnostic Procedures
| X-rays | 10% after deductible |
| Imaging (CT/PET/MRI) | 10% after deductible |
| Blood work | $55 copay after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | first 1 visit(s) $0 then $35 copay after deductible |
| Psychiatric hospital stay | 10% after deductible |
