Freedom Silver 73 – POS

Description

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

Health Care Plan Details

Network type	POS
Deductible	$3,000 per person $3,000 per person
Out-of-pocket max	$7,250 per person $14,500 per family
Metal tier	Silver

Visit Copay

Primary care visit	$30 copay
Specialist visit	$60 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$60 copay
Emergency room	$550 copay after deductible
Ambulance	30% coinsurance after deductible
Hospital stay (facility)	$1500 copay per Day after deductible
Hospital stay (physician)	No charge after deductible
Outpatient procedure (facility)	$1000 copay after deductible
Outpatient procedure (physician)	No charge after deductible
Physical rehabilitation	$30 copay after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	$4500 copay after deductible

Pharmacy, Drugs, and Medication

Generic	$20 copay
Brand	$60 copay after deductible
Non-preferred Brand	$100 copay after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	$300 copay after deductible
Imaging (CT/PET/MRI)	$300 copay after deductible
Blood work	No charge after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$30 copay
Psychiatric hospital stay	$1500 copay per Day after deductible

Health Plan Provider Information

Health Plan Benefits	https://PrimewellHealth.com/documents/Marketplace/2024INDFreedomSilver73SummaryOfBenefitsAndCoverage.pdf
Drug and medication plan formulary	https://PrimewellHealth.com/documents/Marketplace/2024CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf
Search doctor list	https://PrimewellHealth.com/provider/providersearch