IFP Silver 70 HSA ON – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge after deductible
Specialist visit: $80 copay after deductible
Urgent care visit: $50 copay after deductible
Description
Health Care Plan Details
Network type | HMO |
Deductible | $3,295 per person $3,295 per person |
Out-of-pocket max | $6,590 per person $13,180 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | No charge after deductible |
Specialist visit | $80 copay after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $50 copay after deductible |
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 | $80 copay after deductible |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | 50% after deductible |
Pharmacy, Drugs, and Medication
Generic | $15 copay after deductible |
Brand | $65 copay after deductible |
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 | 50% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 50% after deductible |
Psychiatric hospital stay | 50% after deductible |