Standard Silver WellCare – PPO

94% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: $5 copay

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Description

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

Health Care Plan Details

Network type PPO
Deductible $0 per person $0 per person
Out-of-pocket max $1,800 per person $3,600 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 $5 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 No charge

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 25% coinsurance

Pharmacy, Drugs, and Medication

Generic No charge
Brand $15 copay
Non-preferred Brand $50 copay
Specialty $150 copay

Lab Tests and Diagnostic Procedures

X-rays 25% coinsurance
Imaging (CT/PET/MRI) 25% coinsurance
Blood work 25% coinsurance

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay 25% coinsurance

Health Plan Provider Information

Health Plan Benefits https://api.centene.com/SBC/2024/44007NC0120005-06.pdf
Drug and medication plan formulary https://marketplace.wellcarenc.com/resources/pharmacy-resources.html
Search doctor list https://marketplace.wellcarenc.com/findadoc