Connect Silver-2 2900 Indiv Med Deductible – HMO

73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $60 copay
Urgent care visit: $40 copay

SKU: 73943NC007003004 Category:

Description

This plan has 73% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible Success

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Out-of-pocket max $7,550 per person $15,100 per family
Metal tier Silver

Visit Copay

Primary care visit $20 copay
Specialist visit $60 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $40 copay
Emergency room $800 copay after deductible
Ambulance 50% coinsurance after deductible
Hospital stay (facility) 50% coinsurance after deductible
Hospital stay (physician) 50% coinsurance after deductible
Outpatient procedure (facility) 50% coinsurance after deductible
Outpatient procedure (physician) 50% coinsurance after deductible
Physical rehabilitation 50% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic $3 copay
Brand 50% coinsurance after deductible
Non-preferred Brand 50% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays 50% coinsurance after deductible
Imaging (CT/PET/MRI) 50% coinsurance after deductible
Blood work 50% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 50% coinsurance after deductible
Psychiatric hospital stay 50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-nc-944670-s-connect-2-2900.pdf
Drug and medication plan formulary https://www.cigna.com/ifp-drug-lists
Search doctor list https://www.cigna.com/ifp-providers