Apex $3,000 w/Copay P-S Silver – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $75 copay
Urgent care visit: $75 copay
Description
Health Care Plan Details
| Network type | PPO |
| Deductible | See brochure See brochure |
| Out-of-pocket max | N/A per person N/A per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $75 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $75 copay |
| Emergency room | 25% after deductible |
| Ambulance | 25% after deductible |
| Hospital stay (facility) | 25% after deductible |
| Hospital stay (physician) | 25% after deductible |
| Outpatient procedure (facility) | 25% after deductible |
| Outpatient procedure (physician) | 25% after deductible |
| Physical rehabilitation | $75 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 25% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $25 copay |
| Brand | 25% after deductible |
| Non-preferred Brand | 25% after deductible |
| Specialty | 50% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 25% after deductible |
| Imaging (CT/PET/MRI) | 25% after deductible |
| Blood work | 25% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | 25% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/RUDujsdp3sheBJKJqTgPCAY8.pdf |
| Drug and medication plan formulary | https://www.healthpartners.com/hp/pharmacy/druglist/preferredrx/index.html |
