Market HMO 6900 – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $45 copay
Specialist visit: $110 copay
Urgent care visit: $110 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $6,900 per person $6,900 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $45 copay |
| Specialist visit | $110 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $110 copay |
| Emergency room | $400 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 | $45 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/60CA6E6AA2B842C5B1AFCDB9DF4F4099.pdf |
| Drug and medication plan formulary | https://www.medmutual.com/2024Drugs |
| Search doctor list | https://providersearch.medmutual.com/ |
