Chorus Silver Copay – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $100 copay
Urgent care visit: $45 copay
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $9,000 per person $18,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $40 copay |
| Specialist visit | $100 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $45 copay |
| Emergency room | $1,500 copay |
| Ambulance | $130 copay |
| Hospital stay (facility) | $1250 copay per Day |
| Hospital stay (physician) | $100 copay |
| Outpatient procedure (facility) | $130 copay |
| Outpatient procedure (physician) | $100 copay |
| Physical rehabilitation | $80 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $1,250 copay |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $140 copay |
| Non-preferred Brand | 40% coinsurance after deductible |
| Specialty | 40% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $140 copay |
| Imaging (CT/PET/MRI) | $1,000 copay |
| Blood work | $50 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $40 copay |
| Psychiatric hospital stay | $1250 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://chorushealthplans.org/CCHP/media/PDFs/2024/Chorus-Silver-Copay-2024-(rev-2023-0608).pdf |
| Drug and medication plan formulary | https://www.chorushealthplans.org/formulary |
| Search doctor list | https://www.chorushealthplans.org/Find-a-Doc |
