Community Select Silver 019 (No Deductible for PCP, Specialists & Generics, Free 24/7 Telehealth) – HMO

Description

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

Health Care Plan Details

Network type	HMO
Deductible	Success Your progress has been saved. We have sent an email to with a link to continue your application ×
Out-of-pocket max	$1,600 per person $3,200 per family
Metal tier	Silver

Visit Copay

Primary care visit	$5 copay
Specialist visit	$25 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$25 copay
Emergency room	10% coinsurance
Ambulance	$25 copay
Hospital stay (facility)	10% coinsurance
Hospital stay (physician)	No charge
Outpatient procedure (facility)	10% coinsurance
Outpatient procedure (physician)	10% coinsurance
Physical rehabilitation	$25 copay

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	10% coinsurance

Pharmacy, Drugs, and Medication

Generic	Share
Brand	$15 copay
Non-preferred Brand	$40 copay
Specialty	30% coinsurance

Lab Tests and Diagnostic Procedures

X-rays	$5 copay
Imaging (CT/PET/MRI)	10% coinsurance
Blood work	$5 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	This is the amount you’re responsible for when receiving services provided by a physician, surgeon, or other specialist.
Psychiatric hospital stay	10% coinsurance

Health Plan Provider Information

Health Plan Benefits	https://www.communityhealthchoice.org/wp-content/uploads/2023/06/27248TX0010019-06-2024.pdf
Drug and medication plan formulary	https://www.communityhealthchoice.org/wp-content/uploads/2023/04/formulary-select-2024.pdf
Search doctor list	https://providersearch.communityhealthchoice.org/