Anthem Silver Tiered 6000 CSR 87 – HMO

87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $45 copay
Urgent care visit: $35 copay

SKU: 48396ME071007405 Category:

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $575 per person $575 per person
Out-of-pocket max $2,300 per person $4,600 per family
Metal tier Silver

Visit Copay

Primary care visit $15 copay
Specialist visit $45 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $35 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% after deductible

Maternitowny and Pregnancy

Labor, delivery, hospital stay 35% after deductible

Pharmacy, Drugs, and Medication

Generic $10 copay
Brand $40 copay
Non-preferred Brand 35% after deductible
Specialty 35% after deductible

Lab Tests and Diagnostic Procedures

X-rays 35% after deductible
Imaging (CT/PET/MRI) 35% after deductible
Blood work $15 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $15 copay
Psychiatric hospital stay 35% after deductible

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/kvXJSp6YbEhL1DqVkf7YGQqt.pdf