Physicians Health Plan HMO Exclusive Silver – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $45 copay
Specialist visit: $80 copay
Urgent care visit: $85 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $7,000 per person $7,000 per person |
| Out-of-pocket max | $8,000 per person $16,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $45 copay |
| Specialist visit | $80 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $85 copay |
| Emergency room | 40% coinsurance after deductible |
| Ambulance | 40% coinsurance after deductible |
| Hospital stay (facility) | 40% coinsurance after deductible |
| Hospital stay (physician) | 40% coinsurance after deductible |
| Outpatient procedure (facility) | 40% coinsurance after deductible |
| Outpatient procedure (physician) | 40% coinsurance after deductible |
| Physical rehabilitation | $80 copay after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 40% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $30 copay |
| Brand | $80 copay |
| Non-preferred Brand | $200 copay |
| Specialty | 20% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 40% coinsurance after deductible |
| Imaging (CT/PET/MRI) | $150 copay after deductible |
| Blood work | 40% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $45 copay |
| Psychiatric hospital stay | 40% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2024Plans/PHP_Excl_Silver_OnMp_60829MI0190017-01_2024SBC_SNN05600_RX08E546.pdf |
| Drug and medication plan formulary | https://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Prescription-Drug-List-6-Tier-2024.pdf |
| Search doctor list | https://www.phpmichigan.com/upload/docs/Directories/2023/Exclusive%20Provider%20Directory%2008%2025%202023.pdf |
