OMNIA Silver HSA – EPO
73% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $10 copay after deductible
Specialist visit: $25 copay after deductible
Urgent care visit: $50 copay after deductible
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $2,100 per person $2,100 per person |
| Out-of-pocket max | $7,500 per person $15,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $10 copay after deductible |
| Specialist visit | $25 copay after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay after deductible |
| Emergency room | $100 plus 20% after deductible copay, $100 plus 20% after deductible |
| Ambulance | 20% after deductible |
| Hospital stay (facility) | 20% after deductible |
| Hospital stay (physician) | 20% after deductible |
| Outpatient procedure (facility) | 20% after deductible |
| Outpatient procedure (physician) | 20% after deductible |
| Physical rehabilitation | 20% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 20% after deductible |
Pharmacy, Drugs, and Medication
| Generic | 40% after deductible |
| Brand | 40% after deductible |
| Non-preferred Brand | 40% after deductible |
| Specialty | 40% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $25 copay after deductible |
| Imaging (CT/PET/MRI) | 20% after deductible |
| Blood work | $25 copay after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 20% after deductible |
| Psychiatric hospital stay | 20% after deductible |
