MercyCare HMO Silver Option B – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $5,400 per person $5,400 per person |
| Out-of-pocket max | $5,400 per person $10,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge after deductible |
| Specialist visit | No charge after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | No charge after deductible |
| Emergency room | No charge after deductible |
| Ambulance | No charge after deductible |
| Hospital stay (facility) | No charge after deductible |
| Hospital stay (physician) | No charge after deductible |
| Outpatient procedure (facility) | No charge after deductible |
| Outpatient procedure (physician) | No charge after deductible |
| Physical rehabilitation | No charge after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
| Generic | No charge after deductible |
| Brand | No charge after deductible |
| Non-preferred Brand | No charge after deductible |
| Specialty | No charge after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | No charge after deductible |
| Imaging (CT/PET/MRI) | No charge after deductible |
| Blood work | No charge after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge after deductible |
| Psychiatric hospital stay | No charge after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://res.cloudinary.com/dpmykpsih/image/upload/mercyhealth-site-398/media/e909cb96950048b4be77c7ca2333e003/2024-jan-sbc-silver-option-b-co-100-5400-ded-wi58326wi0090016_091223.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/ |
