Silver 70 PPO – PPO
Network type: PPO
Coverage tier: Silver
Primary care visit: $50 copay
Specialist visit: $90 copay
Urgent care visit: $50 copay
SKU: 70285CA1290001
Categories: Acampo, Acton, Adelanto, Adin, Agoura Hills, Aguanga, Ahwahnee, Alameda, Alamo, Albany, Albion, Alderpoint, Alhambra, Aliso Viejo, Alleghany, Alpaugh, Alpine, Alta, Altadena, Altaville, Alturas, Alviso, Amador City, Amboy, American Canyon, Anaheim, Anderson, Angels Camp, Angelus Oaks, Angwin, Annapolis, Antelope, Antioch, Anza, Apple Valley, Applegate, Aptos, Arbuckle, Arcadia, Arcata, Armona, Arnold, Aromas, Arroyo Grande, Artesia, Artois, Arvin, Atascadero, Atherton, Atwater, Auberry, Auburn, Avalon, Avenal, Avery, Avila Beach, Azusa, Badger, Baker, Bakersfield, Baldwin Park, Ballico, Bangor, Banning, Bard, Barstow, Bass Lake, Bayside, Beale Afb, Beaumont, Beckwourth, Belden, Bell Gardens, Bella Vista, Bellflower, Belmont, Belvedere Tiburon, Ben Lomond, Benicia, Benton, Berkeley, Berry Creek, Bethel Island, Beverly Hills, Bieber, Big Bar, Big Bear City, Big Bear Lake, Big Bend, Big Creek, Big Oak Flat, Big Pine, Big Sur, Biggs, Biola, Birds Landing, Bishop, Blairsden Graeagle, Blocksburg, Bloomington, Blue Jay, Blue Lake, Blythe, Bodega, Bodega Bay, Bodfish, Bolinas, Bonita, Bonsall, Boonville, Boron, Borrego Springs, Boulder Creek, Boulevard, Bradley, Brandeis, Branscomb, Brawley, Brea, Brentwood, Bridgeport, Bridgeville, Brisbane, Brookdale, Brooks, Browns Valley, Brownsville, Buellton, Buena Park, Burbank, Burlingame, Burney, Burnt Ranch, Burson, Butte City, Buttonwillow, Byron, Cabazon, Calabasas, Calexico, Caliente, California, California City, California Hot Springs, Calimesa, Calipatria, Calistoga, Callahan, Calpine, Camarillo, Cambria, Camino, Camp Meeker, Camp Nelson, Camp Pendleton, Campbell, Campo, Campo Seco, Camptonville, Canby, Canoga Park, Cantil, Cantua Creek, Canyon, Canyon Country, Canyon Dam, Capay, Capistrano Beach, Capitola, Cardiff By The Sea, Carlotta, Carlsbad, Carmel, Carmel By The Sea, Carmel Valley, Carmichael, Carnelian Bay, Carpinteria, Carson, Caruthers, Casmalia, Caspar, Cassel, Castaic, Castella, Castro Valley, Castroville, Cathedral City, Catheys Valley, Cayucos, Cazadero, Cedar Glen, Cedarpines Park, Cedarville, Ceres, Cerritos, Challenge, Chatsworth, Chester, Chico, Chilcoot, Chinese Camp, Chino, Chino Hills, Chowchilla, Chualar, Chula Vista, Citrus Heights, Claremont, Clarksburg, Clayton, Clearlake, Clearlake Oaks, Clements, Clio, Clipper Mills, Cloverdale, Clovis, Coachella, Coalinga, Coarsegold, Cobb, Coleville, Colfax, Coloma, Colton, Columbia, Colusa, Comptche, Compton, Concord, Cool, Copperopolis, Corcoran, Corning, Corona, Corona Del Mar, Coronado, Corte Madera, Costa Mesa, Cotati, Cottonwood, Coulterville, Courtland, Covelo, Covina, Coyote, Crescent City, Crescent Mills, Cressey, Crestline, Creston, Crockett, Crows Landing, Culver City, Cupertino, Cutler, Cypress, Daggett, Daly City, Dana Point, Danville, Darwin, Davenport, Davis, Davis Creek, Death Valley, Deer Park, Del Mar, Del Rey, Delano, Delhi, Denair, Descanso, Desert Center, Desert Hot Springs, Diablo, Diamond Bar, Diamond Springs, Dillon Beach, Dinuba, Discovery Bay, Dixon, Dobbins, Dorris, Dos Palos, Dos Rios, Douglas City, Downey, Downieville, Doyle, Drytown, Duarte, Dublin, Ducor, Dulzura, Duncans Mills, Dunlap, Dunnigan, Dunsmuir, Durham, Dutch Flat, Eagleville, Earlimart, Earp, Eastvale, Echo Lake, Edison, Edwards, El Cajon, El Centro, El Cerrito, El Dorado, El Dorado Hills, El Granada, El Monte, El Nido, El Portal, El Segundo, El Sobrante, Eldridge, Elk, Elk Creek, Elk Grove, Elmira, Elverta, Emeryville, Emigrant Gap, Empire, Encinitas, Encino, Escalon, Escondido, Esparto, Essex, Etna, Eureka, Exeter, Fair Oaks, Fairfax, Fairfield, Fall River Mills, Fallbrook, Farmersville, Farmington, Fawnskin, Fellows, Felton, Ferndale, Fiddletown, Fields Landing, Fillmore, Finley, Firebaugh, Fish Camp, Five Points, Floriston, Flournoy, Folsom, Fontana, Foothill Ranch, Forbestown, Forest Falls, Forest Knolls, Forest Ranch, Foresthill, Forestville, Forks Of Salmon, Fort Bidwell, Fort Bragg, Fort Dick, Fort Irwin, Fort Jones, Fortuna, Fountain Valley, Fowler, Frazier Park, Freedom, Fremont, French Camp, French Gulch, Fresno, Friant, Fullerton, Fulton, Galt, Garberville, Garden Grove, Garden Valley, Gardena, Gasquet, Gazelle, Georgetown, Gerber, Geyserville, Gilroy, Glen Ellen, Glencoe, Glendale, Glendora, Glenhaven, Glenn, Glennville, Gold Run, Goleta, Gonzales, Goodyears Bar, Goshen, Granada Hills, Grand Terrace, Granite Bay, Grass Valley, Graton, Green Valley Lake, Greenbrae, Greenfield, Greenview, Greenville, Greenwood, Grenada, Gridley, Grimes, Grizzly Flats, Groveland, Grover Beach, Guadalupe, Gualala, Guatay, Guerneville, Guinda, Gustine, Hacienda Heights, Half Moon Bay, Hamilton City, Hanford, Happy Camp, Harbor City, Hat Creek, Hathaway Pines, Hawaiian Gardens, Hawthorne, Hayfork, Hayward, Healdsburg, Heber, Helendale, Helm, Hemet, Herald, Hercules, Herlong, Hermosa Beach, Hesperia, Hickman, Hidden Valley Lake, Highland, Hilmar, Hinkley, Hollister, Holtville, Homeland, Homewood, Honeydew, Hood, Hoopa, Hopland, Hornbrook, Hornitos, Hughson, Hume, Huntington Beach, Huntington Park, Huron, Hyampom, Hydesville, Idyllwild, Igo, Imperial, Imperial Beach, Independence, Indian Wells, Indio, Inglewood, Inverness, Ione, Irvine, Isleton, Ivanhoe, Jackson, Jacumba, Jamestown, Jamul, Janesville, Jenner, Jolon, Joshua Tree, Julian, Junction City, June Lake, Jurupa Valley, Kaweah, Keeler, Keene, Kelseyville, Kenwood, Kerman, Kernville, Kettleman City, Keyes, King City, Kings Beach, Kings Canyon National Pk, Kingsburg, Kirkwood, Klamath, Klamath River, Kneeland, Knights Landing, Knightsen, Korbel, Kyburz, La Canada Flintridge, La Crescenta, La Grange, La Habra, La Honda, La Jolla, La Mesa, La Mirada, La Palma, La Puente, La Quinta, La Verne, Ladera Ranch, Lafayette, Laguna Beach, Laguna Hills, Laguna Niguel, Laguna Woods, Lagunitas, Lake Arrowhead, Lake City, Lake Elsinore, Lake Forest, Lake Hughes, Lake Isabella, Lakehead, Lakeport, Lakeshore, Lakeside, Lakewood, Lamont, Lancaster, Landers, Larkspur, Lathrop, Laton, Lawndale, Laytonville, Le Grand, Lebec, Lee Vining, Leggett, Lemon Cove, Lemon Grove, Lemoore, Lewiston, Likely, Lincoln, Linden, Lindsay, Litchfield, Little River, Littlerock, Live Oak, Livermore, Livingston, Llano, Lockeford, Lockwood, Lodi, Loleta, Loma Linda, Loma Mar, Lomita, Lompoc, Lone Pine, Long Barn, Long Beach, Lookout, Loomis, Los Alamitos, Los Alamos, Los Altos, Los Angeles, Los Banos, Los Gatos, Los Molinos, Los Olivos, Los Osos, Lost Hills, Lotus, Lower Lake, Loyalton, Lucerne, Lucerne Valley, Ludlow, Lynwood, Lytle Creek, Macdoel, Mad River, Madeline, Madera, Madison, Magalia, Malibu, Mammoth Lakes, Manchester, Manhattan Beach, Manteca, Manton, March Air Reserve Base, Maricopa, Marina, Marina Del Rey, Mariposa, Markleeville, Marshall, Martinez, Marysville, Mather, Maxwell, Maywood, Mcarthur, Mcclellan, Mccloud, McFarland, Mckinleyville, McKittrick, Meadow Valley, Meadow Vista, Mecca, Mendocino, Mendota, Menifee, Menlo Park, Mentone, Merced, Meridian, Mi Wuk Village, Middletown, Midpines, Midway City, Milford, Mill Creek, Mill Valley, Millbrae, Millville, Milpitas, Mineral, Mira Loma, Miramonte, Miranda, Mission Hills, Mission Viejo, Modesto, Mojave, Mokelumne Hill, Monrovia, Montague, Montara, Montclair, Monte Rio, Montebello, Monterey, Monterey Park, Montgomery Creek, Montrose, Moorpark, Moraga, Moreno Valley, Morgan Hill, Morongo Valley, Morro Bay, Moss Beach, Moss Landing, Mount Hamilton, Mount Hermon, Mount Laguna, Mount Shasta, Mountain Center, Mountain Ranch, Mountain View, Mt Baldy, Murphys, Murrieta, Myers Flat, Napa, National City, Navarro, Needles, Nelson, Nevada City, New Cuyama, New Pine Creek, Newark, Newberry Springs, Newbury Park, Newcastle, Newhall, Newman, Newport Beach, Newport Coast, Nicasio, Nice, Nicolaus, Niland, Nipomo, Nipton, Norco, North Fork, North Highlands, North Hills, North Hollywood, North Palm Springs, North San Juan, Northridge, Norwalk, Novato, Nubieber, Nuevo, O'Neals, Oak Park, Oak Run, Oak View, Oakdale, Oakhurst, Oakland, Oakley, Oakville, Occidental, Oceano, Oceanside, Ocotillo, Ojai, Olancha, Old Station, Olema, Olivehurst, Olympic Valley, Ontario, Onyx, Orange, Orange Cove, Orangevale, Oregon House, Orick, Orinda, Orland, Orleans, Oro Grande, Orosi, Oroville, Oxnard, Pacific Grove, Pacific Palisades, Pacifica, Pacoima, Paicines, Pala, Palermo, Palm Desert, Palm Springs, Palmdale, Palo Alto, Palo Cedro, Palo Verde, Palomar Mountain, Palos Verdes Peninsula, Panorama City, Paradise, Paramount, Parker Dam, Parlier, Pasadena, Paskenta, Paso Robles, Patterson, Patton, Pauma Valley, Paynes Creek, Pearblossom, Pebble Beach, Penn Valley, Penngrove, Penryn, Perris, Pescadero, Petaluma, Petrolia, Phelan, Phillipsville, Philo, Pico Rivera, Piercy, Pilot Hill, Pine Grove, Pine Mountain Club, Pine Valley, Pinecrest, Pinole, Pinon Hills, Pioneer, Pioneertown, Piru, Pismo Beach, Pittsburg, Pixley, Placentia, Placerville, Planada, Platina, Playa Del Rey, Playa Vista, Pleasant Grove, Pleasant Hill, Pleasanton, Plymouth, Point Arena, Point Mugu Nawc, Point Reyes Station, Pollock Pines, Pomona, Pope Valley, Port Costa, Port Hueneme, Port Hueneme Cbc Base, Porter Ranch, Porterville, Portola, Portola Valley, Posey, Potrero, Potter Valley, Poway, Prather, Princeton, Proberta, Quincy, Rackerby, Rail Road Flat, Raisin City, Ramona, Ranchita, Rancho Cordova, Rancho Cucamonga, Rancho Mirage, Rancho Palos Verdes, Rancho Santa Fe, Rancho Santa Margarita, Ravendale, Raymond, Red Bluff, Redcrest, Redding, Redlands, Redondo Beach, Redway, Redwood City, Redwood Valley, Reedley, Represa, Rescue, Reseda, Rialto, Richgrove, Richmond, Richvale, Rimforest, Rio Dell, Rio Linda, Rio Nido, Rio Oso, Rio Vista, Ripon, River Pines, Riverbank, Riverdale, Riverside, Robbins, Rocklin, Rodeo, Rohnert Park, Rosamond, Rosemead, Roseville, Ross, Rough And Ready, Round Mountain, Rowland Heights, Rumsey, Running Springs, Rutherford, Ryde, Sacramento, Saint Helena, Salida, Salinas, Salton City, Salyer, Samoa, San Andreas, San Anselmo, San Ardo, San Bernardino, San Bruno, San Carlos, San Clemente, San Diego, San Dimas, San Fernando, San Francisco, San Gabriel, San Geronimo, San Gregorio, San Jacinto, San Joaquin, San Jose, San Juan Bautista, San Juan Capistrano, San Leandro, San Lorenzo, San Lucas, San Luis Obispo, San Marcos, San Marino, San Martin, San Mateo, San Miguel, San Pablo, San Pedro, San Quentin, San Rafael, San Ramon, San Simeon, San Ysidro, Sanger, Santa Ana, Santa Barbara, Santa Clara, Santa Clarita, Santa Cruz, Santa Fe Springs, Santa Margarita, Santa Maria, Santa Monica, Santa Paula, Santa Rosa, Santa Ynez, Santa Ysabel, Santee, Saratoga, Sausalito, Scotia, Scott Bar, Scotts Valley, Seal Beach, Seaside, Sebastopol, Seeley, Seiad Valley, Selma, Sequoia National Park, Shafter, Shandon, Shasta, Shasta Lake, Shaver Lake, Sheridan, Sherman Oaks, Shingle Springs, Shingletown, Shoshone, Sierra City, Sierra Madre, Sierraville, Signal Hill, Silverado, Simi Valley, Skyforest, Sloughhouse, Smartsville, Smith River, Snelling, Soda Springs, Solana Beach, Soledad, Solvang, Somerset, Somes Bar, Somis, Sonoma, Sonora, Soquel, Soulsbyville, South Dos Palos, South El Monte, South Gate, South Lake Tahoe, South Pasadena, South San Francisco, Spreckels, Spring Valley, Springville, Squaw Valley, Standish, Stanford, Stanton, Stevenson Ranch, Stevinson, Stewarts Point, Stinson Beach, Stirling City, Stockton, Stonyford, Stratford, Strathmore, Strawberry, Strawberry Valley, Studio City, Sugarloaf, Suisun City, Sultana, Summerland, Sun Valley, Sunland, Sunnyvale, Sunol, Sunset Beach, Surfside, Susanville, Sutter, Sutter Creek, Sylmar, Taft, Tahoe City, Tahoe Vista, Tahoma, Tarzana, Taylorsville, Tecate, Tecopa, Tehachapi, Tehama, Temecula, Temple City, Templeton, Termo, Terra Bella, The Sea Ranch, Thermal, Thornton, Thousand Oaks, Thousand Palms, Three Rivers, Tipton, Tollhouse, Tomales, Topanga, Topaz, Torrance, Trabuco Canyon, Tracy, Tranquillity, Traver, Travis Afb, Tres Pinos, Trinidad, Trinity Center, Trona, Truckee, Tujunga, Tulare, Tulelake, Tuolumne, Tupman, Turlock, Tustin, Twain, Twain Harte, Twentynine Palms, Twin Bridges, Twin Peaks, Ukiah, Union City, Universal City, Upland, Upper Lake, Vacaville, Valencia, Vallecito, Vallejo, Valley Center, Valley Ford, Valley Springs, Valley Village, Valyermo, Van Nuys, Venice, Ventura, Verdugo City, Vernalis, Victor, Victorville, Vidal, Villa Grande, Villa Park, Vina, Vinton, Visalia, Vista, Volcano, Wallace, Walnut, Walnut Creek, Walnut Grove, Warner Springs, Wasco, Washington, Waterford, Watsonville, Weaverville, Weed, Weimar, Weldon, Wendel, Weott, West Covina, West Hills, West Hollywood, West Point, West Sacramento, Westlake Village, Westley, Westminster, Westmorland, Westport, Westwood, Wheatland, Whitethorn, Whitewater, Whitmore, Whittier, Wildomar, Williams, Willits, Willow Creek, Willows, Wilmington, Wilseyville, Wilton, Winchester, Windsor, Winnetka, Winterhaven, Winters, Winton, Wishon, Witter Springs, Wofford Heights, Woodacre, Woodbridge, Woodlake, Woodland, Woodland Hills, Woody, Wrightwood, Yermo, Yettem, Yolo, Yorba Linda, Yorkville, Yosemite National Park, Yountville, Yreka, Yuba City, Yucaipa, Yucca Valley, Zamora, Zenia
Description
Health Care Plan Details
| Network type | PPO |
| Deductible | $5,400 per person $5,400 per person |
| Out-of-pocket max | $9,100 per person $18,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $50 copay |
| Specialist visit | $90 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay |
| Emergency room | $450 copay |
| Ambulance | $250 copay |
| Hospital stay (facility) | 30% after deductible |
| Hospital stay (physician) | 30% coinsurance |
| Outpatient procedure (facility) | 30% coinsurance |
| Outpatient procedure (physician) | 30% coinsurance |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 30% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $19 copay |
| Brand | $60 copay after deductible |
| Non-preferred Brand | $90 copay after deductible |
| Specialty | 20% after deductible, up to $250 copay, 20% after deductible, up to $250 |
Lab Tests and Diagnostic Procedures
| X-rays | $95 copay |
| Imaging (CT/PET/MRI) | $325 copay |
| Blood work | $50 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | 30% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/K7YPJCsDjd5BawxqKKBmQhEe.pdf |
