Personal Choice PPO Silver Classic – PPO
87% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: 10% after deductible
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $2,250 per person $2,250 per person |
| Out-of-pocket max | $3,000 per person $6,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 10% after deductible |
| Emergency room | 10% after deductible |
| Ambulance | 10% after deductible |
| Hospital stay (facility) | 10% coinsurance |
| Hospital stay (physician) | 10% coinsurance |
| Outpatient procedure (facility) | 10% coinsurance |
| Outpatient procedure (physician) | 10% coinsurance |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 10% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | 40% after deductible |
| Non-preferred Brand | 50% after deductible |
| Specialty | 50% after deductible, up to $500 copay, 50% after deductible, up to $500 |
Lab Tests and Diagnostic Procedures
| X-rays | 10% coinsurance |
| Imaging (CT/PET/MRI) | 10% coinsurance |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | 10% coinsurance |
