Apex $3,150 Plus Cost Share Reduction Silver – PPO
73% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible
Specialist visit: first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible
Urgent care visit: first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $3,150 per person $3,150 per person |
| Out-of-pocket max | $7,250 per person $14,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible |
| Specialist visit | first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible |
| Emergency room | 15% after deductible |
| Ambulance | 15% after deductible |
| Hospital stay (facility) | 15% after deductible |
| Hospital stay (physician) | 15% after deductible |
| Outpatient procedure (facility) | 15% after deductible |
| Outpatient procedure (physician) | 15% after deductible |
| Physical rehabilitation | 15% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 15% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $25 copay |
| Brand | 15% after deductible |
| Non-preferred Brand | 15% after deductible |
| Specialty | 50% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 15% after deductible |
| Imaging (CT/PET/MRI) | 15% after deductible |
| Blood work | 15% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | first 3 visit(s) $0 then 15% after deductible copay, first 3 visit(s) $0 then 15% after deductible |
| Psychiatric hospital stay | 15% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/a73nSHGoFE1qQLvdj9sJn2ho.pdf |
| Drug and medication plan formulary | https://www.healthpartners.com/hp/pharmacy/druglist/preferredrx/index.html |
