Choice Gold Alternative POS – POS
Network type: POS
Coverage tier: Gold
Primary care visit: $40 copay
Specialist visit: $50 copay
Urgent care visit: 30% coinsurance
Description
Health Care Plan Details
| Network type | POS |
| Deductible | $2,000 per person $2,000 per person |
| Out-of-pocket max | $8,300 per person $16,600 per family |
| Metal tier | Gold |
Visit Copay
| Primary care visit | $40 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 30% coinsurance |
| Emergency room | 30% after deductible |
| Ambulance | 30% after deductible |
| Hospital stay (facility) | 30% after deductible |
| Hospital stay (physician) | 30% after deductible |
| Outpatient procedure (facility) | 30% after deductible |
| Outpatient procedure (physician) | 30% after deductible |
| Physical rehabilitation | 30% after deductible |
Maternitowny and Pregnancy
Pharmacy, Drugs, and Medication
| Generic | $10 per script copay |
| Brand | $40 per script copay |
| Non-preferred Brand | $60 per script after deductible copay |
| Specialty | 20% after deductible, up to $150 per script copay, 20% after deductible, up to $150 per script |
Lab Tests and Diagnostic Procedures
| X-rays | $50 per procedure copay |
| Imaging (CT/PET/MRI) | first 5 visit(s) $75 per procedure then $0 copay |
| Blood work | $10 per procedure copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | 30% after deductible |
