RMHP Colorado Doctors Plan Silver Advantage-E ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin) – 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	$7,500 per person $15,000 per family
Metal tier	Silver

Visit Copay

Primary care visit	$5 copay
Specialist visit	$110 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$75 copay
Emergency room	$500 copay after deductible
Ambulance	30% coinsurance after deductible
Hospital stay (facility)	30% coinsurance after deductible
Hospital stay (physician)	30% coinsurance after deductible
Outpatient procedure (facility)	30% coinsurance after deductible
Outpatient procedure (physician)	30% coinsurance after deductible
Physical rehabilitation	30% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	30% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$3 copay
Brand	$50 copay after deductible
Non-preferred Brand	30% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	30% coinsurance after deductible
Imaging (CT/PET/MRI)	30% coinsurance after deductible
Blood work	$25 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	30% coinsurance after deductible
Psychiatric hospital stay	30% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.uhc.com/ifp/sbc.97879CO0420014-04.en.2024
Drug and medication plan formulary	https://www.uhc.com/xcodruglist2024
Search doctor list	https://www.uhc.com/xcodocfindcdp2024