Chorus Standard Silver 100 – EPO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	EPO
Deductible	$100 per person $100 per person
Out-of-pocket max	$1,250 per person $2,500 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	$20 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	5% coinsurance after deductible
Emergency room	5% coinsurance after deductible
Ambulance	5% coinsurance after deductible
Hospital stay (facility)	5% coinsurance after deductible
Hospital stay (physician)	5% coinsurance after deductible
Outpatient procedure (facility)	5% coinsurance after deductible
Outpatient procedure (physician)	5% coinsurance after deductible
Physical rehabilitation	5% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	5% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$5 copay
Brand	$15 copay
Non-preferred Brand	5% coinsurance after deductible
Specialty	5% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	5% coinsurance after deductible
Imaging (CT/PET/MRI)	5% coinsurance after deductible
Blood work	$20 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	$10 copay
Psychiatric hospital stay	5% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://chorushealthplans.org/CCHP/media/PDFs/2024/Chorus-Standard-Silver-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