Connect Silver-4B 0 Indiv Med Deductible – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $15 copay
Urgent care visit: $15 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | Success
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| Out-of-pocket max | $1,800 per person $3,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $15 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $15 copay |
| Emergency room | 30% coinsurance |
| Ambulance | 5% coinsurance |
| Hospital stay (facility) | 5% coinsurance |
| Hospital stay (physician) | 5% coinsurance |
| Outpatient procedure (facility) | 5% coinsurance |
| Outpatient procedure (physician) | 5% coinsurance |
| Physical rehabilitation | 5% coinsurance |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 5% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $50 copay |
| Non-preferred Brand | 50% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 5% coinsurance |
| Imaging (CT/PET/MRI) | 5% coinsurance |
| Blood work | 5% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 5% coinsurance |
| Psychiatric hospital stay | 5% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/tgaE2ui6Bw6A91uPxVsUsD9Q.pdf |
| Drug and medication plan formulary | https://www.cigna.com/individuals-families/member-guide/individuals-families-drug-list?consumerID=cigna&indicator=IFP&pdlYearType=CD |
| Search doctor list | https://www.cigna.com/ifp-providers |
