MercyCare HMO Silver Option A – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $30 copay
Urgent care visit: $35 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $2,800 per person $5,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | $30 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $35 copay |
| Emergency room | 20% coinsurance |
| Ambulance | 20% coinsurance |
| Hospital stay (facility) | No charge |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | No charge |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $15 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | No charge |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $25 copay |
| Non-preferred Brand | $50 copay |
| Specialty | $150 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge |
| Imaging (CT/PET/MRI) | No charge |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $15 copay |
| Psychiatric hospital stay | No charge |
Health Plan Provider Information
| Health Plan Benefits | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/65a01000327640a1ad525218eb19d783/2024-jan-sbc-silver-option-a-94-co-100-0-ded-wi58326wi0090002-06_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/ |
