Health Options Clear Choice Silver $3500 HMO NE Dental CSR 87 – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: first 1 visit(s) $0 then $15 copay
Specialist visit: $25 copay
Urgent care visit: $40 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $1,275 per person $1,275 per person |
| Out-of-pocket max | $2,750 per person $5,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | first 1 visit(s) $0 then $15 copay |
| Specialist visit | $25 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $40 copay |
| Emergency room | 20% after deductible |
| Ambulance | 20% after deductible |
| 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 | $15 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 20% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $20 copay |
| Non-preferred Brand | $60 copay after deductible |
| Specialty | $180 copay after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 20% after deductible |
| Imaging (CT/PET/MRI) | 20% after deductible |
| Blood work | 20% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | first 1 visit(s) $0 then $15 copay |
| Psychiatric hospital stay | 20% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/yaL9t39zmfCAssspHap4AMkx.pdf |
| Drug and medication plan formulary | https://www.healthoptions.org/members/medications#drug-formulary |
