UHC Silver-C Virtual First (Disponible en espanol) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $60 copay
Urgent care visit: $60 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $100 per person $100 per person |
| Out-of-pocket max | $900 per person $1,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $60 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $60 copay |
| Emergency room | 40% coinsurance after deductible |
| Ambulance | 10% coinsurance after deductible |
| Hospital stay (facility) | 10% coinsurance after deductible |
| Hospital stay (physician) | 10% coinsurance after deductible |
| Outpatient procedure (facility) | 10% after deductible |
| Outpatient procedure (physician) | 10% coinsurance after deductible |
| Physical rehabilitation | 10% coinsurance after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 10% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $1 copay |
| Brand | $45 copay after deductible |
| Non-preferred Brand | 40% coinsurance after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 10% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 10% coinsurance after deductible |
| Blood work | $5 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | 10% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/1nE757mbmuXxsaPdoCfEzV8v.pdf |
| Drug and medication plan formulary | https://www.uhc.com/xvadruglist2024 |
| Search doctor list | https://www.uhc.com/xvadocfindvf2024 |
