Select Health Value Silver $1500 Medical Deductible – EPO

Description

Health Care Plan Details

Network type	EPO
Deductible	Plan summary Get our guide to the Essential Health Benefits covered by this plan and all other Marketplace plans. Monthly premium Get a quote for this plan Your premium is the amount you pay for health insurance each month. Deductible $1,500 per person $1,500 per person $1,500 per person Your deductible is the amount you pay for healthcare services before your insurance starts helping you cover the cost. Depending on the plan, some basic services (like doctor visits and prescriptions) may be covered before your deductible is met. Out-of-pocket max $9,450 per person $18,900 per family $18,900 per family This is the most you will have to pay for healthcare services during your coverage period (typically 12 months). After you spend this amount on deductibles, copayments, and coinsurance, your health insurance plan will pay the rest. Note: monthly premiums don’t count towards your out-of-pocket max. Network type EPO The type of network you choose (HMO, PPO, POS, or EPO) will determine which providers (doctors, pharmacies, hospitals, and specialist) you can see. • HMO plans usually limit coverage to providers who are within the plan’s network, and require a doctor’s referral to see specialists. • PPO plans usually cover some of the cost of out-of-network providers (but not as much as for in-network providers), and don’t require a doctor’s referral to see specialists. • EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). Metal tier Silver Metal levels (which include bronze, silver, gold, and platinum) determine how you will split the cost of your healthcare services with your insurance carrier. • Bronze plans have the lowest monthly premiums and the highest costs when you need care • Silver plans have moderate monthly premiums and moderate costs when you need care. • Gold plans have high monthly premiums and low costs when you need care. • Platinum plans have the highest monthly premiums and the lowest costs when you need care.
Out-of-pocket max	$9,450 per person $18,900 per family
Metal tier	Silver

Visit Copay

Primary care visit	$30 copay
Specialist visit	$90 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$45 copay
Emergency room	$1,500 copay
Ambulance	$200 copay
Hospital stay (facility)	first 3 day(s) $3,150 per day then $0 copay after deductible
Hospital stay (physician)	No charge
Outpatient procedure (facility)	50% after deductible
Outpatient procedure (physician)	50% after deductible
Physical rehabilitation	$25 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay

first 3 day(s) $3,150 per day then $0 copay

Pharmacy, Drugs, and Medication

Generic	$15 copay
Brand	$100 copay after deductible
Non-preferred Brand	50% after deductible
Specialty	50% after deductible

Lab Tests and Diagnostic Procedures

X-rays	50% after deductible
Imaging (CT/PET/MRI)	50% after deductible
Blood work	$15 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	50% after deductible
Psychiatric hospital stay	first 3 day(s) $3,150 per day then $0 copay after deductible

Health Plan Provider Information