Flex Silver – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: first 4 visit(s) $0 then $0 copay after deductible
Specialist visit: first 4 visit(s) $5 then $5 copay after deductible
Urgent care visit: first 4 visit(s) $5 then $5 copay after deductible
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $150 per person $150 per person |
| Out-of-pocket max | $2,400 per person $4,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | first 4 visit(s) $0 then $0 copay after deductible |
| Specialist visit | first 4 visit(s) $5 then $5 copay after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | first 4 visit(s) $5 then $5 copay after deductible |
| Emergency room | 5% after deductible |
| Ambulance | 5% after deductible |
| Hospital stay (facility) | 5% after deductible |
| Hospital stay (physician) | 5% after deductible |
| Outpatient procedure (facility) | 5% after deductible |
| Outpatient procedure (physician) | 5% after deductible |
| Physical rehabilitation | $5 copay after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 5% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $5 per script copay |
| Brand | 10% after deductible |
| Non-preferred Brand | 40% after deductible |
| Specialty | 40% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 5% after deductible |
| Imaging (CT/PET/MRI) | 5% after deductible |
| Blood work | 5% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | first 4 visit(s) $0 then $0 copay after deductible |
| Psychiatric hospital stay | 5% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/YfzkTcurcxAKm89AQRxtX4p9.pdf |
| Drug and medication plan formulary | https://wa.kaiserpermanente.org/static/pdf/public/formulary/if-sg-2024.pdf?kp_shortcut_referrer=kp.org/wa/7formulary2024 |
