Neighborhood VALUE (CSR87) – HMO

87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $10 copay
Specialist visit: $20 copay
Urgent care visit: $20 copay

SKU: 77514RI001000105 Category:

Description

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

Health Care Plan Details

Network type HMO
Deductible $1,200 per person $1,200 per person
Out-of-pocket max $3,000 per person $6,000 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 $20 copay
Emergency room 10% after deductible
Hospital stay (facility) 10% after deductible

Maternitowny and Pregnancy

Pharmacy, Drugs, and Medication

Generic $5 copay
Brand $35 copay
Non-preferred Brand $50 copay
Specialty 10% after deductible

Lab Tests and Diagnostic Procedures

Mental and Psychiatric Health Care

Health Plan Provider Information