Anthem Silver Mountain Enhanced HMO 5000 $0 Select Drugs – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $35 copay
Specialist visit: 35% after deductible
Urgent care visit: $80 copay
Description
Health Care Plan Details
Network type | HMO |
Deductible | $5,000 per person $5,000 per person |
Out-of-pocket max | $8,000 per person $16,000 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $35 copay |
Specialist visit | 35% after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $80 copay |
Emergency room | 35% after deductible |
Ambulance | 35% after deductible |
Hospital stay (facility) | 35% after deductible |
Hospital stay (physician) | 35% after deductible |
Outpatient procedure (facility) | 35% after deductible |
Outpatient procedure (physician) | 35% after deductible |
Physical rehabilitation | $35 copay |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | 35% after deductible |
Pharmacy, Drugs, and Medication
Generic | $5 copay |
Brand | $40 copay |
Non-preferred Brand | 35% after deductible |
Specialty | 50% after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 35% after deductible |
Imaging (CT/PET/MRI) | 35% after deductible |
Blood work | 35% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 35% after deductible |
Psychiatric hospital stay | 35% after deductible |