Standard Silver ST OON IHC Network Marketplace DP FP Dep 29 – POS
94% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: $10 copay
Specialist visit: $20 copay
Urgent care visit: $30 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 | $1,000 per person $2,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $10 copay |
| Specialist visit | $20 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay |
| Emergency room | $50 copay |
| Ambulance | $50 copay |
| Hospital stay (facility) | $100 copay |
| Hospital stay (physician) | $25 copay |
| Outpatient procedure (facility) | $25 copay |
| Outpatient procedure (physician) | $25 copay |
| Physical rehabilitation | $15 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $125 copay |
Pharmacy, Drugs, and Medication
| Generic | $6 copay |
| Brand | $15 copay |
| Non-preferred Brand | $30 copay |
Lab Tests and Diagnostic Procedures
| X-rays | $20 copay |
| Imaging (CT/PET/MRI) | $20 copay |
| Blood work | $20 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $10 copay |
| Psychiatric hospital stay | $100 copay |