Anthem Silver 750 S05 – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: 15% after deductible
Specialist visit: 15% after deductible
Urgent care visit: 15% after deductible
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $750 per person $750 per person |
| Out-of-pocket max | $2,050 per person $4,100 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | 15% after deductible |
| Specialist visit | 15% after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 15% after deductible |
| Emergency room | 15% after deductible |
| Ambulance | 15% after deductible |
| Hospital stay (facility) | $250 plus 50% after deductible copay, $250 plus 50% after deductible |
| Hospital stay (physician) | 15% after deductible |
| Outpatient procedure (facility) | 15% after deductible |
| Outpatient procedure (physician) | 15% after deductible |
| Physical rehabilitation | 15% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $250 plus 50% after deductible copay, $250 plus 50% after deductible |
Pharmacy, Drugs, and Medication
| Generic | 35% after deductible |
| Brand | 35% after deductible |
| Non-preferred Brand | 40% after deductible |
| Specialty | 40% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 15% after deductible |
| Imaging (CT/PET/MRI) | $250 plus 50% after deductible copay, $250 plus 50% after deductible |
| Blood work | 15% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 15% after deductible |
| Psychiatric hospital stay | $250 plus 50% after deductible copay, $250 plus 50% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/xkrXpi3NzyXVx39CBdvyej8k.pdf |
