Regence Cascade Silver Individual and Family Network – EPO

Network type: EPO
Coverage tier: Silver
Primary care visit: first 2 visit(s) $0 then $30 copay
Specialist visit: first 2 visit(s) $0 then $65 copay
Urgent care visit: first 2 visit(s) $0 then $65 copay

Description

Health Care Plan Details

Network type EPO
Deductible $2,500 per person $2,500 per person
Out-of-pocket max $9,200 per person $18,400 per family
Metal tier Silver

Visit Copay

Primary care visit first 2 visit(s) $0 then $30 copay
Specialist visit first 2 visit(s) $0 then $65 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care first 2 visit(s) $0 then $65 copay
Emergency room $800 copay after deductible
Ambulance $375 copay
Hospital stay (facility) first 5 day(s) $800 per day then $0 copay after deductible
Hospital stay (physician) $800 copay after deductible
Outpatient procedure (facility) $600 copay after deductible
Outpatient procedure (physician) $200 copay after deductible
Physical rehabilitation $40 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay first 5 day(s) $800 per day then $0 copay after deductible

Pharmacy, Drugs, and Medication

Generic $25 copay
Brand $75 copay
Non-preferred Brand $250 copay after deductible
Specialty $250 copay after deductible

Lab Tests and Diagnostic Procedures

X-rays $65 copay
Imaging (CT/PET/MRI) 30% after deductible
Blood work $40 copay

Mental and Psychiatric Health Care

Mental Health outpatient services first 2 visit(s) $0 then $30 copay
Psychiatric hospital stay first 5 day(s) $800 per day then $0 copay after deductible

Health Plan Provider Information