Connect Silver-3 650 Indiv Med Deductible – EPO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	EPO
Deductible	Success Your progress has been saved. We have sent an email to with a link to continue your application ×
Out-of-pocket max	$3,150 per person $6,300 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	$30 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$30 copay
Emergency room	15% coinsurance after deductible
Ambulance	15% coinsurance after deductible
Hospital stay (facility)	15% coinsurance after deductible
Hospital stay (physician)	15% coinsurance after deductible
Outpatient procedure (facility)	15% coinsurance after deductible
Outpatient procedure (physician)	15% coinsurance after deductible
Physical rehabilitation	15% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	15% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$3 copay
Brand	$65 copay
Non-preferred Brand	40% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	15% coinsurance after deductible
Imaging (CT/PET/MRI)	15% coinsurance after deductible
Blood work	$30 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	15% coinsurance after deductible
Psychiatric hospital stay	15% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-ms-944625-s-connect-3-650.pdf
Drug and medication plan formulary	https://www.cigna.com/ifp-drug-lists
Search doctor list	https://www.cigna.com/ifp-providers