Plus with Northwestern Medicine Silver-2 2500 Indiv Med Ded – Rx Copay – HMO

Description

This plan has 73% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$2,500 per person $2,500 per person
Out-of-pocket max	$7,250 per person $14,500 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	$100 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$35 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	40% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	40% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	No charge
Brand	$125 copay
Non-preferred Brand	$285 copay
Specialty	$758 copay

Lab Tests and Diagnostic Procedures

X-rays	40% coinsurance after deductible
Imaging (CT/PET/MRI)	40% coinsurance after deductible
Blood work	40% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	40% coinsurance after deductible
Psychiatric hospital stay	40% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-il-nwm-944559-s-plus-2-2500rx.pdf
Drug and medication plan formulary	https://www.cigna.com/ifp-drug-lists
Search doctor list	https://www.cigna.com/ifp-providers