Focused Silver – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $45 copay
Specialist visit: $100 copay
Urgent care visit: $60 copay
Description
Health Care Plan Details
Network type | EPO |
Deductible | $6,300 per person $6,300 per person |
Out-of-pocket max | $8,000 per person $16,000 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $45 copay |
Specialist visit | $100 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $60 copay |
Emergency room | 50% coinsurance after deductible |
Ambulance | 50% coinsurance after deductible |
Hospital stay (facility) | 50% coinsurance after deductible |
Hospital stay (physician) | 50% coinsurance after deductible |
Outpatient procedure (facility) | 50% coinsurance after deductible |
Outpatient procedure (physician) | 50% coinsurance after deductible |
Physical rehabilitation | 50% coinsurance after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 50% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | $3 copay |
Brand | $75 copay |
Non-preferred Brand | 50% coinsurance after deductible |
Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 50% coinsurance after deductible |
Imaging (CT/PET/MRI) | 50% coinsurance after deductible |
Blood work | $50 copay |
Mental and Psychiatric Health Care
Mental Health outpatient services | $45 copay |
Psychiatric hospital stay | 50% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://api.centene.com/SBC/2024/21663FL0130112-01.pdf |
Drug and medication plan formulary | https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html |
Search doctor list | https://ambetter.sunshinehealth.com/findadoc |