Anthem Silver Mountain Enhanced HMO 800 S05 Rx Copay $0 Select Drugs – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $50 copay
Urgent care visit: $75 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $800 per person $800 per person |
| Out-of-pocket max | $2,600 per person $5,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $5 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $75 copay |
| Emergency room | $250 plus 40% after deductible copay, $250 plus 40% after deductible |
| Ambulance | 40% after deductible |
| Hospital stay (facility) | $250 plus 40% after deductible copay, $250 plus 40% after deductible |
| Hospital stay (physician) | 40% after deductible |
| Outpatient procedure (facility) | 40% after deductible |
| Outpatient procedure (physician) | 40% after deductible |
| Physical rehabilitation | $5 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $250 plus 40% after deductible copay, $250 plus 40% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $30 copay |
| Non-preferred Brand | $70 copay |
| Specialty | $450 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 40% after deductible |
| Imaging (CT/PET/MRI) | $250 plus 50% after deductible copay, $250 plus 50% after deductible |
| Blood work | 40% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 40% after deductible |
| Psychiatric hospital stay | $250 plus 40% after deductible copay, $250 plus 40% after deductible |
