Elevate by Medica Silver Enhanced – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $10 copay
Specialist visit: $40 copay
Urgent care visit: $10 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $2,000 per person $4,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $10 copay |
| Specialist visit | $40 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $10 copay |
| Emergency room | 10% coinsurance |
| Ambulance | 10% coinsurance |
| Hospital stay (facility) | 10% coinsurance |
| Hospital stay (physician) | 10% coinsurance |
| Outpatient procedure (facility) | 10% coinsurance |
| Outpatient procedure (physician) | 10% coinsurance |
| Physical rehabilitation | 10% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 10% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $60 copay |
| Non-preferred Brand | 25% coinsurance |
| Specialty | $250 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 10% coinsurance |
| Imaging (CT/PET/MRI) | 10% coinsurance |
| Blood work | 10% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $10 copay |
| Psychiatric hospital stay | 10% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2024-IFBEMSENNE94&uid=FFM.pdf |
| Drug and medication plan formulary | https://www.Medica.com/NEDrugList-2024 |
| Search doctor list | https://www.Medica.com/SearchElevateNetwork-2024 |
