MHP Silver Exchange – HMO

Description

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

Health Care Plan Details

Network type	HMO
Deductible	$250 per person $250 per person
Out-of-pocket max	$1,000 per person $2,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	$15 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$25 copay
Emergency room	10% 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	$5 copay
Brand	$50 copay
Non-preferred Brand	$100 copay
Specialty	30% coinsurance

Lab Tests and Diagnostic Procedures

X-rays	10% coinsurance after deductible
Imaging (CT/PET/MRI)	10% coinsurance after deductible
Blood work	10% coinsurance after deductible

Mental and Psychiatric Health Care

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

Health Plan Provider Information

Health Plan Benefits	https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/community/2024/2024_Cmty_INDV_HMO-SILVER_EXCHANGE_94_SBC.pdf
Drug and medication plan formulary	https://www.mclarenhealthplan.org/mclaren-health-plan/drug-formulary-search-and-resources
Search doctor list	https://www.mclarenhealthplan.org/mclaren-health-plan/provider-directory-mhp