Franklin Silver + Vision + Adult Dental – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $50 copay
Urgent care visit: $20 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $1,750 per person $1,750 per person |
| Out-of-pocket max | $2,900 per person $5,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $20 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $20 copay |
| Emergency room | $250 copay |
| Ambulance | $125 copay |
| Hospital stay (facility) | $350 per day after deductible copay |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $150 copay after deductible |
| Outpatient procedure (physician) | $25 copay after deductible |
| Physical rehabilitation | $30 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $350 copay after deductible |
Pharmacy, Drugs, and Medication
| Generic | $3 copay |
| Brand | 30% coinsurance |
| Non-preferred Brand | 50% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | $75 copay |
| Imaging (CT/PET/MRI) | $250 copay |
| Blood work | $30 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $20 copay |
| Psychiatric hospital stay | $350 per day after deductible copay |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/RFWLLqD4aQjhCfJUECKkWBKU.pdf |
