iDirect Silver Copay Silver NS OON IHC Network Marketplace DP FP Dep 29 – POS

87% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: $35 copay
Specialist visit: $60 copay
Urgent care visit: $75 copay

SKU: 18029NY126001305 Category:

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type POS
Deductible $0 per person $0 per person
Out-of-pocket max $3,000 per person $6,000 per family
Metal tier Silver

Visit Copay

Primary care visit $35 copay
Specialist visit $60 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room $250 copay
Ambulance $250 copay
Hospital stay (facility) $1,000 copay
Hospital stay (physician) No charge
Outpatient procedure (facility) $200 copay
Outpatient procedure (physician) No charge
Physical rehabilitation $60 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay $1,000 copay

Pharmacy, Drugs, and Medication

Generic $15 copay
Brand $50 copay
Non-preferred Brand 50% coinsurance

Lab Tests and Diagnostic Procedures

X-rays $60 copay
Imaging (CT/PET/MRI) $85 copay
Blood work $35 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $35 copay
Psychiatric hospital stay $1,000 copay

Health Plan Provider Information