Chorus Silver Copay 100 – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $40 copay
Urgent care visit: $45 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $700 per person $1,400 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | $40 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $45 copay |
| Emergency room | $100 copay |
| Ambulance | $40 copay |
| Hospital stay (facility) | $70 copay per Day |
| Hospital stay (physician) | $40 copay |
| Outpatient procedure (facility) | $40 copay |
| Outpatient procedure (physician) | $40 copay |
| Physical rehabilitation | $30 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $70 copay |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $25 copay |
| Non-preferred Brand | 20% coinsurance after deductible |
| Specialty | 20% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $80 copay |
| Imaging (CT/PET/MRI) | $60 copay |
| Blood work | $30 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $15 copay |
| Psychiatric hospital stay | $70 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://chorushealthplans.org/CCHP/media/PDFs/2024/Chorus-Silver-Copay-100-2024-(rev-2023-0608).pdf |
| Drug and medication plan formulary | https://www.chorushealthplans.org/formulary |
| Search doctor list | https://www.chorushealthplans.org/Find-a-Doc |