Anthem Colorado Option Silver Mountain Enhanced Std – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $80 copay
Urgent care visit: $80 copay

Description

Health Care Plan Details

Network type HMO
Deductible $4,750 per person $4,750 per person
Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $80 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $80 copay
Emergency room 40% after deductible
Ambulance 40% 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 40% after deductible

Maternitowny and Pregnancy

Labor, delivery, hospital stay 40% after deductible

Pharmacy, Drugs, and Medication

Generic $20 copay
Brand $125 copay
Non-preferred Brand $300 copay
Specialty $650 copay

Lab Tests and Diagnostic Procedures

X-rays 40% after deductible
Imaging (CT/PET/MRI) 40% after deductible
Blood work 40% after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 40% after deductible
Psychiatric hospital stay 40% after deductible

Health Plan Provider Information