Jefferson Health Plans + Balanced + Silver + HMO + 87% – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $40 copay
Urgent care visit: $40 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $500 per person $500 per person |
| Out-of-pocket max | $3,150 per person $6,300 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $20 copay |
| Specialist visit | $40 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $40 copay |
| Emergency room | $600 copay |
| Ambulance | $150 copay |
| Hospital stay (facility) | first 5 day(s) $200 per day then $0 copay |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | $150 copay after deductible |
| Outpatient procedure (physician) | No charge after deductible |
| Physical rehabilitation | $45 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | first 5 day(s) $200 per day then $0 copay |
Pharmacy, Drugs, and Medication
| Generic | $8 copay |
| Brand | $50 copay |
| Non-preferred Brand | $125 copay |
| Specialty | 25% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $135 copay |
| Imaging (CT/PET/MRI) | $135 per procedure copay |
| Blood work | $100 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $40 copay |
| Psychiatric hospital stay | first 5 day(s) $200 per day then $0 copay |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/27wUYsAua5eZ6qcpnLyqKTGR.pdf |
| Drug and medication plan formulary | https://www.jeffersonhealthplans.com/ |
