Constant Care Silver 1 200 – HMO

73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $30 copay

SKU: 84481WA006000404 Category:

Description

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

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $7,125 per person $14,250 per family
Metal tier Silver

Visit Copay

Primary care visit $30 copay
Specialist visit $60 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $30 copay
Emergency room 35% coinsurance
Ambulance 50% coinsurance
Hospital stay (facility) 35% coinsurance
Hospital stay (physician) 35% coinsurance
Outpatient procedure (facility) $1,250 copay
Outpatient procedure (physician) $200 copay
Physical rehabilitation $60 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay 35% coinsurance

Pharmacy, Drugs, and Medication

Generic $22 copay
Brand $65 copay after deductible
Non-preferred Brand 50% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays $95 copay
Imaging (CT/PET/MRI) $950 copay
Blood work $60 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $30 copay
Psychiatric hospital stay 35% coinsurance

Health Plan Provider Information