OMNIA Silver – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $15 copay
Urgent care visit: $30 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $625 per person $1,250 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $5 copay |
| Specialist visit | $15 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay |
| Emergency room | $100 copay |
| Ambulance | No charge |
| Hospital stay (facility) | first 5 day(s) $200 per day then $0 copay |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $150 copay |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $15 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | first 5 day(s) $200 per day then $0 copay |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | 10% after deductible |
| Non-preferred Brand | 30% after deductible |
| Specialty | 30% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $15 copay |
| Imaging (CT/PET/MRI) | $15 copay |
| Blood work | $15 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $5 copay |
| Psychiatric hospital stay | first 5 day(s) $200 per day then $0 copay |
