Imperial Preferred Silver – HMO

Description

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

Health Care Plan Details

Network type	HMO
Deductible	$3,100 per person $3,100 per person
Out-of-pocket max	$7,550 per person $15,100 per family
Metal tier	Silver

Visit Copay

Primary care visit	$25 copay
Specialist visit	30% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	30% coinsurance after deductible
Emergency room	30% coinsurance after deductible
Ambulance	30% coinsurance after deductible
Hospital stay (facility)	30% coinsurance after deductible
Hospital stay (physician)	30% coinsurance after deductible
Outpatient procedure (facility)	30% coinsurance after deductible
Outpatient procedure (physician)	30% coinsurance after deductible
Physical rehabilitation	$50 copay

Maternitowny and Pregnancy

Well baby care	30% coinsurance after deductible
Labor, delivery, hospital stay	30% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$10 copay
Brand	30% coinsurance after deductible
Non-preferred Brand	30% coinsurance after deductible
Specialty	30% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	30% coinsurance after deductible
Imaging (CT/PET/MRI)	30% coinsurance after deductible
Blood work	30% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$25 copay
Psychiatric hospital stay	30% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://documents.imperialhealthplan.com/2024/Marketplace/Provider%20Directory/Arizona/Imperial%20Preferred%20Silver_85533AZ0020001-04_CY2024.pdf.pdf
Drug and medication plan formulary	https://exchange.imperialhealthplan.com/arizona/drug-formulary/
Search doctor list	https://exchange.imperialhealthplan.com/arizona/provider-directory/