Select Health Value Silver $1500 Medical Deductible – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: $10 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | Success
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| Out-of-pocket max | $2,400 per person $4,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $10 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $10 copay |
| Emergency room | $200 copay |
| Ambulance | $50 copay |
| Hospital stay (facility) | first 3 day(s) $450 per day then $0 copay |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | 20% coinsurance |
| Outpatient procedure (physician) | 20% coinsurance |
| Physical rehabilitation | $10 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | first 3 day(s) $450 per day then $0 copay |
Pharmacy, Drugs, and Medication
| Generic | No charge |
| Brand | $15 copay |
| Non-preferred Brand | 10% coinsurance |
| Specialty | 30% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 20% coinsurance |
| Imaging (CT/PET/MRI) | 20% coinsurance |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 20% coinsurance |
| Psychiatric hospital stay | first 3 day(s) $450 per day then $0 copay |
