MercyCare HMO Silver Option A – HMO
73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $100 copay
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $6,500 per person $6,500 per person |
| Out-of-pocket max | $7,000 per person $14,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $50 copay |
| Specialist visit | $100 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $100 copay |
| Emergency room | 50% coinsurance after deductible |
| Ambulance | 50% coinsurance after deductible |
| Hospital stay (facility) | 50% coinsurance after deductible |
| Hospital stay (physician) | 50% coinsurance after deductible |
| Outpatient procedure (facility) | 50% coinsurance after deductible |
| Outpatient procedure (physician) | 50% coinsurance after deductible |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 50% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $50 copay |
| Non-preferred Brand | $100 copay |
| Specialty | $500 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 50% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 50% coinsurance after deductible |
| Blood work | 50% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | 50% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/d2901bd6f768458192b28acd66d1e67f/2024-jan-sbc-silver-option-a-73-co-50-6500-ded-wi58326wi0090002-04_091223.pdf |
| Drug and medication plan formulary | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/63f009c4df4441b894923f17ebbb4e1b/wi-qhp-formulary-011124.pdf |
| Search doctor list | https://www.mercycarehealthplans.com/find-a-providerfacility/ |
