AvMed Entrust Silver 300 Dental+Vision (2024) – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: $40 copay
Specialist visit: $80 copay
Urgent care visit: $125 copay

Description

Health Care Plan Details

Network type HMO
Deductible $3,000 per person $3,000 per person
Out-of-pocket max $7,650 per person $15,300 per family
Metal tier Silver

Visit Copay

Primary care visit $40 copay
Specialist visit $80 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $125 copay
Emergency room $500 copay after deductible
Ambulance $200 copay
Hospital stay (facility) $900 copay per Day after deductible
Hospital stay (physician) No charge after deductible
Outpatient procedure (facility) $725 copay after deductible
Outpatient procedure (physician) No charge after deductible
Physical rehabilitation $80 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay $900 copay after deductible

Pharmacy, Drugs, and Medication

Generic $20 copay
Brand $80 copay
Non-preferred Brand $100 copay
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays $100 copay
Imaging (CT/PET/MRI) $300 copay
Blood work $30 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $40 copay
Psychiatric hospital stay $900 copay per Day after deductible

Health Plan Provider Information

Health Plan Benefits https://www.avmed.org/images/pdf/providers/patients/eligibility/AVINHS16380101240623.pdf
Drug and medication plan formulary https://www.avmed.org/media/li3fglxe/2024-individual-and-family-plan-formulary-non-standard.pdf
Search doctor list https://avmed.sapphirecareselect.com/?network_id=112&ci=AVMED&geo_location=