Clear Cost Silver Plan – HMO

94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $12 copay
Urgent care visit: $12 copay

SKU: 75605NM039025106 Category:

Description

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

Health Care Plan Details

Network type HMO
Deductible $150 per person $150 per person
Out-of-pocket max $1,250 per person $2,500 per family
Metal tier Silver

Visit Copay

Primary care visit $5 copay
Specialist visit $12 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $12 copay
Emergency room $45 copay after deductible
Ambulance $12 copay
Hospital stay (facility) $45 copay per Stay after deductible
Hospital stay (physician) $40 copay
Outpatient procedure (facility) $40 copay
Outpatient procedure (physician) $40 copay
Physical rehabilitation $5 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay $45 copay after deductible

Pharmacy, Drugs, and Medication

Generic $3 copay
Brand $10 copay
Non-preferred Brand $60 copay after deductible
Specialty $30 copay

Lab Tests and Diagnostic Procedures

X-rays $12 copay
Imaging (CT/PET/MRI) $12 copay
Blood work $12 copay

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay No charge

Health Plan Provider Information

Health Plan Benefits https://www.bcbsnm.com/sbc/ind/sbc-sh6d05cnninmp-nm-2024.pdf
Drug and medication plan formulary https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_NM_5T_HIE.pdf
Search doctor list https://my.providerfinderonline.com/?ci=nm-bluecommunityhmo&corp_code=NM