Connect Silver-4 0 Indiv Med Deductible – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $25 copay
Urgent care visit: $10 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
Network type | HMO |
Deductible | Success
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Out-of-pocket max | $1,000 per person $2,000 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | No charge |
Specialist visit | $25 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $10 copay |
Emergency room | $250 copay |
Ambulance | 15% coinsurance |
Hospital stay (facility) | 15% coinsurance |
Hospital stay (physician) | 15% coinsurance |
Outpatient procedure (facility) | 15% coinsurance |
Outpatient procedure (physician) | 15% coinsurance |
Physical rehabilitation | 15% coinsurance |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 15% coinsurance |
Pharmacy, Drugs, and Medication
Generic | No charge |
Brand | $50 copay |
Non-preferred Brand | 50% coinsurance |
Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
X-rays | 15% coinsurance |
Imaging (CT/PET/MRI) | 15% coinsurance |
Blood work | 15% coinsurance |
Mental and Psychiatric Health Care
Mental Health outpatient services | 15% coinsurance |
Psychiatric hospital stay | 15% coinsurance |
Health Plan Provider Information
Health Plan Benefits | https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-il-944533-s-connect-4-0.pdf |
Drug and medication plan formulary | https://www.cigna.com/ifp-drug-lists |
Search doctor list | https://www.cigna.com/ifp-providers |