HA Silver AH – POS
73% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: $5 copay after deductible
Specialist visit: $5 copay after deductible
Urgent care visit: $5 copay after deductible
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | POS |
| Deductible | $4,725 per person $4,725 per person |
| Out-of-pocket max | $5,225 per person $10,450 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $5 copay after deductible |
| Specialist visit | $5 copay after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $5 copay after deductible |
| Emergency room | $500 copay after deductible |
| Ambulance | No charge after deductible |
| Hospital stay (facility) | $500 copay per Day after deductible |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | $5 copay after deductible |
| Outpatient procedure (physician) | $5 copay after deductible |
| Physical rehabilitation | $5 copay after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
| Generic | $100 copay |
| Brand | $1,000 copay |
| Non-preferred Brand | $2,000 copay |
| Specialty | $5,225 copay |
Lab Tests and Diagnostic Procedures
| X-rays | $5 copay after deductible |
| Imaging (CT/PET/MRI) | $375 copay after deductible |
| Blood work | $5 copay after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $5 copay after deductible |
| Psychiatric hospital stay | $500 copay per Day after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://secure.healthadvantage-hmo.com/members/ViewSbc.aspx?id=60007&year=2024 |
| Drug and medication plan formulary | http://www.healthadvantage-hmo.com/ha-formulary-2024 |
| Search doctor list | https://secure.healthadvantage-hmo.com/providerdirectory/trueblueppo.aspx |
