Anthem Silver Mountain Enhanced HMO 2800 $0 Select Drugs – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $10 copay
Specialist visit: 30% after deductible
Urgent care visit: $75 copay
Description
Health Care Plan Details
Network type | HMO |
Deductible | $2,800 per person $2,800 per person |
Out-of-pocket max | $9,450 per person $18,900 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $10 copay |
Specialist visit | 30% after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $75 copay |
Emergency room | $350 plus 30% after deductible copay, $350 plus 30% after deductible |
Ambulance | 30% after deductible |
Hospital stay (facility) | $500 plus 30% after deductible copay, $500 plus 30% after deductible |
Hospital stay (physician) | 30% after deductible |
Outpatient procedure (facility) | 30% after deductible |
Outpatient procedure (physician) | 30% after deductible |
Physical rehabilitation | $10 copay |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | $500 plus 30% after deductible copay, $500 plus 30% after deductible |
Pharmacy, Drugs, and Medication
Generic | 30% after deductible |
Brand | 30% after deductible |
Non-preferred Brand | 30% after deductible |
Specialty | 30% after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 30% after deductible |
Imaging (CT/PET/MRI) | $250 plus 30% after deductible copay, $250 plus 30% after deductible |
Blood work | 30% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 30% after deductible |
Psychiatric hospital stay | $500 plus 30% after deductible copay, $500 plus 30% after deductible |