Silver 87 HMO – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: $25 copay
Urgent care visit: $15 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $800 per person $800 per person |
| Out-of-pocket max | $3,150 per person $6,300 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | $25 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $15 copay |
| Emergency room | $150 copay |
| Ambulance | $75 copay |
| Hospital stay (facility) | 20% after deductible |
| Hospital stay (physician) | 20% coinsurance |
| Outpatient procedure (facility) | 20% coinsurance |
| Outpatient procedure (physician) | 20% coinsurance |
| Physical rehabilitation | $15 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 20% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $6 copay |
| Brand | $25 copay after deductible |
| Non-preferred Brand | $45 copay after deductible |
| Specialty | 15% after deductible, up to $150 copay, 15% after deductible, up to $150 |
Lab Tests and Diagnostic Procedures
| X-rays | $40 copay |
| Imaging (CT/PET/MRI) | $100 copay |
| Blood work | $20 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $15 copay |
| Psychiatric hospital stay | 20% after deductible |
