Chorus Silver Copay 150 – EPO
87% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $30 copay
Specialist visit: $60 copay
Urgent care visit: $45 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $2,400 per person $4,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | $60 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $45 copay |
| Emergency room | $200 copay |
| Ambulance | $75 copay |
| Hospital stay (facility) | $100 copay per Day |
| Hospital stay (physician) | $60 copay |
| Outpatient procedure (facility) | $75 copay |
| Outpatient procedure (physician) | $75 copay |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $100 copay |
Pharmacy, Drugs, and Medication
| Generic | $15 copay |
| Brand | $70 copay |
| Non-preferred Brand | 30% coinsurance after deductible |
| Specialty | 30% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $100 copay |
| Imaging (CT/PET/MRI) | $80 copay |
| Blood work | $30 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $30 copay |
| Psychiatric hospital stay | $100 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://chorushealthplans.org/CCHP/media/PDFs/2024/Chorus-Silver-Copay-150-2024-(rev-2023-0608).pdf |
| Drug and medication plan formulary | https://www.chorushealthplans.org/formulary |
| Search doctor list | https://www.chorushealthplans.org/Find-a-Doc |