Market HMO Select Silver – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $70 copay
Urgent care visit: $70 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $8,250 per person $16,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $70 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $70 copay |
| Emergency room | $1,000 copay |
| Ambulance | $1,000 copay |
| Hospital stay (facility) | $2500 copay per Day |
| Hospital stay (physician) | $200 copay |
| Outpatient procedure (facility) | $1,000 copay |
| Outpatient procedure (physician) | $200 copay |
| Physical rehabilitation | $70 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $2,500 copay |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $200 copay |
| Non-preferred Brand | This is the amount you will pay for a brand name drug prescription. |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $70 copay |
| Imaging (CT/PET/MRI) | $215 copay |
| Blood work | $25 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | $2500 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://www.medmutual.com/-/media/B877F108BCA2461793C9B34ACA99F636.pdf |
| Drug and medication plan formulary | https://www.medmutual.com/2024Drugs |
| Search doctor list | https://providersearch.medmutual.com/ |
