Physicians Health Plan HMO Exclusive Silver Select Plus – HMO

Description

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

Health Care Plan Details

Network type	HMO
Deductible	$300 per person $300 per person
Out-of-pocket max	$700 per person $1,400 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	20% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	20% coinsurance after deductible
Emergency room	20% coinsurance after deductible
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	20% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$15 copay
Brand	30% coinsurance after deductible
Non-preferred Brand	30% coinsurance after deductible
Specialty	30% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$10 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2024Plans/PHP_Excl_Silver_Select_Plus_CSR94_60829MI0190020-06_2024SBC_SNN06500-RX09E602.pdf
Drug and medication plan formulary	https://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Prescription-Drug-List-6-Tier-2024.pdf
Search doctor list	https://www.phpmichigan.com/upload/docs/Directories/2023/Exclusive%20Provider%20Directory%2008%2025%202023.pdf