Geisinger Marketplace All-Access HMO 25/45/250 – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: $25 copay
Specialist visit: $45 copay
Urgent care visit: $25 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $250 per person $250 per person |
| Out-of-pocket max | $7,600 per person $15,200 per family |
| Metal tier | Gold |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $45 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $25 copay |
| Emergency room | $350 copay |
| Ambulance | No charge |
| Hospital stay (facility) | 20% after deductible |
| Hospital stay (physician) | 20% after deductible |
| Outpatient procedure (facility) | 20% after deductible |
| Outpatient procedure (physician) | 20% after deductible |
| Physical rehabilitation | $45 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 20% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $45 copay after deductible |
| Non-preferred Brand | $80 copay after deductible |
| Specialty | 50% after deductible, up to $7,600 copay, 50% after deductible, up to $7,600 |
Lab Tests and Diagnostic Procedures
| X-rays | $45 copay |
| Imaging (CT/PET/MRI) | 20% after deductible |
| Blood work | 20% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | 20% after deductible |
