RMHP Valley Silver Value-D ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin, Rx Copay) – HMO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$1,000 per person $1,000 per person
Out-of-pocket max	$3,100 per person $6,200 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	15% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	15% coinsurance after deductible
Emergency room	$250 copay after deductible
Ambulance	15% coinsurance after deductible
Hospital stay (facility)	15% coinsurance after deductible
Hospital stay (physician)	15% coinsurance after deductible
Outpatient procedure (facility)	15% coinsurance after deductible
Outpatient procedure (physician)	15% coinsurance after deductible
Physical rehabilitation	15% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	15% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$1 copay
Brand	$50 copay
Non-preferred Brand	$100 copay
Specialty	$200 copay

Lab Tests and Diagnostic Procedures

X-rays	15% coinsurance after deductible
Imaging (CT/PET/MRI)	15% coinsurance after deductible
Blood work	$10 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	15% coinsurance after deductible
Psychiatric hospital stay	15% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.uhc.com/ifp/sbc.97879CO0440004-05.en.2024
Drug and medication plan formulary	https://www.uhc.com/xcodruglist2024
Search doctor list	https://www.uhc.com/xcodocfindrv2024