MHP Silver Exchange VCP – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$3,800 per person $3,800 per person
Out-of-pocket max	$8,550 per person $17,100 per family
Metal tier	Silver

Visit Copay

Primary care visit	$40 copay
Specialist visit	$65 copay after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$75 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	20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$20 copay
Brand	$85 copay
Non-preferred Brand	$150 copay after deductible
Specialty	40% coinsurance after deductible

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	$40 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/community/2024/2024_Cmty_IND_VCP_SILVER_EXCHANGE_SBC.pdf
Drug and medication plan formulary	https://www.mclarenhealthplan.org/mclaren-health-plan/drug-formulary-search-and-resources
Search doctor list	https://www.mclarenhealthplan.org/mclaren-health-plan/provider-directory-mhp