Clear Cost Silver Plan – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $12 copay
Specialist visit: $35 copay
Urgent care visit: $35 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
Network type | HMO |
Deductible | $1,100 per person $1,100 per person |
Out-of-pocket max | $2,950 per person $5,900 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $12 copay |
Specialist visit | $35 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $35 copay |
Emergency room | $105 copay after deductible |
Ambulance | $35 copay |
Hospital stay (facility) | $105 copay per Stay after deductible |
Hospital stay (physician) | $85 copay |
Outpatient procedure (facility) | $85 copay |
Outpatient procedure (physician) | $85 copay |
Physical rehabilitation | $12 copay |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | $105 copay after deductible |
Pharmacy, Drugs, and Medication
Generic | $8 copay |
Brand | $15 copay |
Non-preferred Brand | $100 copay after deductible |
Specialty | $65 copay |
Lab Tests and Diagnostic Procedures
X-rays | $35 copay |
Imaging (CT/PET/MRI) | $35 copay |
Blood work | $35 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-sh5d05cnninmp-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 |