RMHP Valley Silver Value-C ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin, Rx Copay) – HMO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$150 per person $150 per person
Out-of-pocket max	$2,900 per person $5,800 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	5% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	5% coinsurance after deductible
Emergency room	$100 copay after deductible
Ambulance	5% coinsurance after deductible
Hospital stay (facility)	5% coinsurance after deductible
Hospital stay (physician)	5% coinsurance after deductible
Outpatient procedure (facility)	5% coinsurance after deductible
Outpatient procedure (physician)	5% coinsurance after deductible
Physical rehabilitation	5% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	5% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$1 copay
Brand	$30 copay
Non-preferred Brand	$100 copay
Specialty	$200 copay

Lab Tests and Diagnostic Procedures

X-rays	5% coinsurance after deductible
Imaging (CT/PET/MRI)	5% coinsurance after deductible
Blood work	$3 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	5% coinsurance after deductible
Psychiatric hospital stay	5% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.uhc.com/ifp/sbc.97879CO0440004-06.en.2024
Drug and medication plan formulary	https://www.uhc.com/xcodruglist2024
Search doctor list	https://www.uhc.com/xcodocfindrv2024