Plus with Northwestern Medicine Silver-3 350 Indiv Med Ded – Rx Copay – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $50 copay
Urgent care visit: $20 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $350 per person $350 per person |
| Out-of-pocket max | $3,000 per person $6,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $20 copay |
| Emergency room | 35% coinsurance after deductible |
| Ambulance | 35% coinsurance after deductible |
| Hospital stay (facility) | 35% coinsurance after deductible |
| Hospital stay (physician) | 35% coinsurance after deductible |
| Outpatient procedure (facility) | 35% coinsurance after deductible |
| Outpatient procedure (physician) | 35% coinsurance after deductible |
| Physical rehabilitation | 35% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 35% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $100 copay |
| Non-preferred Brand | $250 copay |
| Specialty | $700 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 35% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 35% coinsurance after deductible |
| Blood work | 35% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 35% coinsurance after deductible |
| Psychiatric hospital stay | 35% 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-944560-s-plus-3-350rx.pdf |
| Drug and medication plan formulary | https://www.cigna.com/ifp-drug-lists |
| Search doctor list | https://www.cigna.com/ifp-providers |
