Connect Silver 0 Indiv Med Deductible – EPO

Network type: EPO
Coverage tier: Silver
Primary care visit: $60 copay
Specialist visit: $115 copay
Urgent care visit: $60 copay

SKU: 99248TN0060104 Categories: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Description

Health Care Plan Details

Network type EPO
Deductible Success

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Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Silver

Visit Copay

Primary care visit $60 copay
Specialist visit $115 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $60 copay
Emergency room 50% coinsurance
Ambulance 50% coinsurance
Hospital stay (facility) 50% coinsurance
Hospital stay (physician) 50% coinsurance
Outpatient procedure (facility) 50% coinsurance
Outpatient procedure (physician) 50% coinsurance
Physical rehabilitation 50% coinsurance

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 50% coinsurance

Pharmacy, Drugs, and Medication

Generic $8 copay
Brand 50% coinsurance
Non-preferred Brand 50% coinsurance
Specialty 50% coinsurance

Lab Tests and Diagnostic Procedures

X-rays 50% coinsurance
Imaging (CT/PET/MRI) 50% coinsurance
Blood work 50% coinsurance

Mental and Psychiatric Health Care

Mental Health outpatient services 50% coinsurance
Psychiatric hospital stay 50% coinsurance

Health Plan Provider Information

Health Plan Benefits https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-tn-944785-s-connect0.pdf
Drug and medication plan formulary https://www.cigna.com/ifp-drug-lists
Search doctor list https://www.cigna.com/ifp-providers