Constant Care Silver 1 100 – HMO

94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: No charge

SKU: 84481WA006000406 Category:

Description

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

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $1,025 per person $2,050 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $10 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care No charge
Emergency room 20% coinsurance
Ambulance 25% coinsurance
Hospital stay (facility) 20% coinsurance
Hospital stay (physician) 20% coinsurance
Outpatient procedure (facility) $250 copay
Outpatient procedure (physician) $50 copay
Physical rehabilitation $10 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay 20% coinsurance

Pharmacy, Drugs, and Medication

Generic No charge
Brand $10 copay
Non-preferred Brand 10% coinsurance
Specialty 10% coinsurance

Lab Tests and Diagnostic Procedures

X-rays $30 copay
Imaging (CT/PET/MRI) $125 copay
Blood work $10 copay

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay 20% coinsurance

Health Plan Provider Information