2024 POS 7250 Elite Silver – POS

87% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $60 copay

SKU: 20129IL034004505 Category:

Description

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

Health Care Plan Details

Network type POS
Deductible $1,700 per person $1,700 per person
Out-of-pocket max $2,200 per person $4,400 per family
Metal tier Silver

Visit Copay

Primary care visit $30 copay
Specialist visit $60 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $60 copay
Emergency room 10% coinsurance after deductible
Ambulance 10% coinsurance after deductible
Hospital stay (facility) 10% coinsurance after deductible
Hospital stay (physician) 10% coinsurance after deductible
Outpatient procedure (facility) 10% coinsurance after deductible
Outpatient procedure (physician) 10% coinsurance after deductible
Physical rehabilitation 10% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 10% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic $10 copay
Brand $40 copay
Non-preferred Brand $80 copay
Specialty $250 copay

Lab Tests and Diagnostic Procedures

X-rays $200 copay
Imaging (CT/PET/MRI) 10% coinsurance after deductible
Blood work $100 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $30 copay
Psychiatric hospital stay 10% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits https://www.healthalliance.org/documents/sbc/IL_IND_PUB_SBC_2024_POS_7250_ELITE_SILVER_CSR_87/2024.pdf
Drug and medication plan formulary https://healthalliance.org/documents/formulary/666/2024
Search doctor list https://www.healthalliance.org/Guests/ProviderSearch?DirectoryName=IEX