Paramount Silver 12 HRA – HMO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$250 per person $250 per person
Out-of-pocket max	$1,000 per person $2,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$2 copay
Specialist visit	$4 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$15 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	$5 copay
Brand	$15 copay
Non-preferred Brand	$60 copay
Specialty	30% 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	$2 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://pcl.promedica.org/-/media/paramount/marketplace/2024/sbc2024-silver12HRA_94costsharing.pdf
Drug and medication plan formulary	https://pcl.promedica.org/-/media/paramount/marketplace/2024/2024-marketplace-formulary.pdf
Search doctor list	http://www.MyParamount.org/MarketplaceDirectory