Freedom Silver 94 – POS
94% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: $10 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | POS |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $1,250 per person $2,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $10 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $10 copay |
| Emergency room | $250 copay |
| Ambulance | 10% coinsurance |
| Hospital stay (facility) | $250 copay per Day |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $250 copay |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | No charge |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $750 copay |
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $25 copay after deductible |
| Non-preferred Brand | $60 copay after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $25 copay |
| Imaging (CT/PET/MRI) | $25 copay |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge |
| Psychiatric hospital stay | $250 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://PrimewellHealth.com/documents/Marketplace/2024INDFreedomSilver94SummaryOfBenefitsAndCoverage.pdf |
| Drug and medication plan formulary | https://PrimewellHealth.com/documents/Marketplace/2024CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf |
| Search doctor list | https://PrimewellHealth.com/provider/providersearch |
