Neighborhood VALUE Modified (CSR73) – HMO

73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $75 copay
Urgent care visit: $75 copay

SKU: 77514RI001001104 Category:

Description

This plan has 73% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $4,225 per person $4,225 per person
Out-of-pocket max $7,300 per person $14,600 per family
Metal tier Silver

Visit Copay

Primary care visit $25 copay
Specialist visit $75 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room 40% after deductible
Hospital stay (facility) 40% after deductible

Maternitowny and Pregnancy

Pharmacy, Drugs, and Medication

Generic $10 copay
Brand $40 copay
Non-preferred Brand $55 copay
Specialty 50% after deductible

Lab Tests and Diagnostic Procedures

Mental and Psychiatric Health Care

Health Plan Provider Information