CHRISTUS Silver HD – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $40 copay
Urgent care visit: $40 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $8,600 per person $8,600 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $40 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $40 copay |
| Emergency room | $950 copay after deductible |
| Ambulance | 50% coinsurance after deductible |
| Hospital stay (facility) | $950 copay per Stay after deductible |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | 50% coinsurance after deductible |
| Outpatient procedure (physician) | 50% coinsurance after deductible |
| Physical rehabilitation | $40 copay after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $950 copay after deductible |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $60 copay after deductible |
| Non-preferred Brand | $95 copay after deductible |
| Specialty | 45% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $40 copay |
| Imaging (CT/PET/MRI) | $400 copay after deductible |
| Blood work | 50% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | $950 copay per Stay after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://chppayment.christushealth.org/documents/2024/SBC/66252_CHRISTUS_Silver_HD.pdf |
| Drug and medication plan formulary | https://www.christushealthplan.org/member-resources/pharmacy |
| Search doctor list | https://www.christushealthplan.org/find-a-provider |
