Paramount Silver 4 HRA – HMO

Description

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

Health Care Plan Details

Network type	HMO
Deductible	$1,750 per person $1,750 per person
Out-of-pocket max	$2,500 per person $5,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$5 copay
Specialist visit	$10 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$35 copay
Emergency room	30% coinsurance after deductible
Ambulance	30% coinsurance after deductible
Hospital stay (facility)	30% coinsurance after deductible
Hospital stay (physician)	30% coinsurance after deductible
Outpatient procedure (facility)	30% coinsurance after deductible
Outpatient procedure (physician)	30% coinsurance after deductible
Physical rehabilitation	30% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	30% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$8 copay
Brand	$20 copay
Non-preferred Brand	$100 copay
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	30% coinsurance after deductible
Imaging (CT/PET/MRI)	30% coinsurance after deductible
Blood work	30% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$5 copay
Psychiatric hospital stay	30% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://pcl.promedica.org/-/media/paramount/marketplace/2024/sbc2024-silver4_87costsharing.pdf
Drug and medication plan formulary	https://pcl.promedica.org/-/media/paramount/marketplace/2024/2024-marketplace-formulary.pdf
Search doctor list	http://www.MyParamount.org/MarketplaceDirectory