Focused Silver – HMO

73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $35 copay
Specialist visit: $85 copay
Urgent care visit: $50 copay

SKU: 39006NM001002004 Category:

Description

This plan has 73% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $5,100 per person $5,100 per person
Out-of-pocket max $6,950 per person $13,900 per family
Metal tier Silver

Visit Copay

Primary care visit $35 copay
Specialist visit $85 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $50 copay
Emergency room 50% after deductible
Ambulance 50% after deductible
Hospital stay (facility) 50% after deductible
Hospital stay (physician) 50% after deductible
Outpatient procedure (facility) 50% after deductible
Outpatient procedure (physician) 50% after deductible
Physical rehabilitation $35 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay 50% after deductible

Pharmacy, Drugs, and Medication

Generic $3 copay
Brand $70 copay
Non-preferred Brand 50% after deductible
Specialty 50% after deductible

Lab Tests and Diagnostic Procedures

X-rays 50% after deductible
Imaging (CT/PET/MRI) 50% after deductible
Blood work $40 copay

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay No charge

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/TJYrN3ENFpKbzwmaX3g919e8.pdf
Search doctor list https://ambetter.westernskycommunitycare.com/findadoc