Regence Cascade Silver Legacy 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 |