Market HMO 3850 – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $30 copay, 30% coinsurance after deductible
Specialist visit: $90 copay, 30% coinsurance after deductible
Urgent care visit: $90 copay, 30% coinsurance after deductible
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $3,850 per person $3,850 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $30 copay, 30% coinsurance after deductible |
| Specialist visit | $90 copay, 30% coinsurance after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $90 copay, 30% coinsurance after deductible |
| Emergency room | $350 copay, 30% coinsurance |
| 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 | 30% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 30% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $60 copay |
| Non-preferred Brand | This is the amount you will pay for a brand name drug prescription. |
| Specialty | 50% coinsurance |
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 | 30% coinsurance after deductible |
| Psychiatric hospital stay | 30% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.medmutual.com/-/media/986A7331C84B4515ABAAC4A0A4BC635E.pdf |
| Drug and medication plan formulary | https://www.medmutual.com/2024Drugs |
| Search doctor list | https://providersearch.medmutual.com/ |
