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= |