MercyCare HMO Silver Option A – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: $60 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $750 per person $750 per person |
| Out-of-pocket max | $3,000 per person $6,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $60 copay |
| Emergency room | 20% coinsurance after deductible |
| Ambulance | 20% coinsurance after deductible |
| Hospital stay (facility) | 20% coinsurance after deductible |
| Hospital stay (physician) | 20% coinsurance after deductible |
| Outpatient procedure (facility) | 20% coinsurance after deductible |
| Outpatient procedure (physician) | 20% coinsurance after deductible |
| Physical rehabilitation | $25 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 20% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $40 copay |
| Non-preferred Brand | $60 copay |
| Specialty | $250 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 20% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 20% coinsurance after deductible |
| Blood work | 20% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | 20% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/aa7f2833ed9d494fb1e6a6e5a41dafce/2024-jan-sbc-silver-option-a-87-co-80-750-ded-wi58326wi0090002-05_092123.pdf |
| Drug and medication plan formulary | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/63f009c4df4441b894923f17ebbb4e1b/wi-qhp-formulary-011124.pdf |
| Search doctor list | https://www.mercycarehealthplans.com/find-a-providerfacility/ |
