Sanford Individual Simplicity Enhanced Care Plan $3,700 – PPO

Description

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

Health Care Plan Details

Network type	PPO
Deductible	$0 per person $0 per person
Out-of-pocket max	$1,800 per person $3,600 per family
Metal tier	Silver

Visit Copay

Primary care visit	10% coinsurance
Specialist visit	10% coinsurance
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	10% coinsurance
Emergency room	10% coinsurance
Ambulance	10% coinsurance
Hospital stay (facility)	10% coinsurance
Hospital stay (physician)	10% coinsurance
Outpatient procedure (facility)	10% coinsurance
Outpatient procedure (physician)	10% coinsurance
Physical rehabilitation	10% coinsurance

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	10% coinsurance

Pharmacy, Drugs, and Medication

Generic	10% coinsurance
Brand	This is the amount you will pay for a generic drug prescription.
Non-preferred Brand	10% coinsurance
Specialty	10% coinsurance

Lab Tests and Diagnostic Procedures

X-rays	10% coinsurance
Imaging (CT/PET/MRI)	10% coinsurance
Blood work	10% coinsurance

Mental and Psychiatric Health Care

Mental Health outpatient services	10% coinsurance
Psychiatric hospital stay	10% coinsurance

Health Plan Provider Information

Health Plan Benefits	https://www.sanfordhealthplan.org/-/media/plan-documents/2024/_IND_SIMPLICITY_SD_3700_94_ENHANCED_HP5325.pdf
Drug and medication plan formulary	https://www.sanfordhealthplan.com/-/media/files/documents/members/hp6911-simplicity-and-true-for-individual-and-small-groups-1124.pdf
Search doctor list	https://www3.viiad.com/shp/public/default.asp?SelectedPlan=SHPISP