ACCESS SILVER – POS
73% cost sharing reduction [Popular Plan]
Network type: POS
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $60 copay
Urgent care visit: $75 copay
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
Network type | POS |
Deductible | $5,000 per person $5,000 per person |
Out-of-pocket max | $7,400 per person $14,800 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $20 copay |
Specialist visit | $60 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $75 copay |
Emergency room | 50% after deductible |
Ambulance | 50% after deductible |
Hospital stay (facility) | 40% after deductible |
Hospital stay (physician) | 40% after deductible |
Outpatient procedure (facility) | 40% after deductible |
Outpatient procedure (physician) | 40% after deductible |
Physical rehabilitation | $60 copay |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | 40% after deductible |
Pharmacy, Drugs, and Medication
Generic | $10 per script copay |
Brand | $60 per script copay |
Non-preferred Brand | $150 per script copay |
Specialty | $200 per script copay |
Lab Tests and Diagnostic Procedures
X-rays | 50% after deductible |
Imaging (CT/PET/MRI) | 50% after deductible |
Blood work | 50% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | first 1 visit(s) $0 then $20 copay |
Psychiatric hospital stay | 40% after deductible |
Health Plan Provider Information
Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/dNfRPRrhapf43MKb2SG4QTmM.pdf |
Drug and medication plan formulary | https://mountainhealth.coop/pharmacy/ |