Silver 73 Performance HMO – HMO
73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $35 copay
Specialist visit: $85 copay
Urgent care visit: $35 copay
Description
This plan has 73% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $6,100 per person $12,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $35 copay |
| Specialist visit | $85 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $35 copay |
| Emergency room | $350 copay |
| Ambulance | $250 copay |
| Hospital stay (facility) | 30% coinsurance |
| Hospital stay (physician) | 30% coinsurance |
| Outpatient procedure (facility) | 30% coinsurance |
| Outpatient procedure (physician) | 30% coinsurance |
| Physical rehabilitation | $35 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 30% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $15 copay |
| Brand | $55 copay |
| Non-preferred Brand | $85 copay |
| Specialty | 20%, up to $250 copay, 20%, up to $250 coinsurance |
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 | $35 copay |
| Psychiatric hospital stay | 30% coinsurance |
